Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 3758 | KY |
NPI | 1003136292 |
---|---|
Provider Name | Mary Gray |
First Address | Louisville, KY 40207-4888 |
Second Address | Louisville, KY 40207-4888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 07/08/2019 |