Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-5113 | ID |
NPI | 1003226473 |
---|---|
Provider Name | Erin Kathleen Gray |
First Address | Sandpoint, ID 83864-2132 |
Second Address | Sandpoint, ID 83864-1682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 06/05/2014 |