Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003238437 |
---|---|
Provider Name | Heath Gray |
First Address | Portsmouth, NH 03801-5503 |
Second Address | Portsmouth, NH 03801-5503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2014 |
Last Update Date | 21/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3078870 | (05) | NH |