Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6301009281 | MI |
N | 103K00000X | Behavior Analyst | 6301009281 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301009281 | MI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6301009281 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301009281 | MI |
NPI | 1437383452 |
---|---|
Provider Name | Mr. Scott Michael Gray |
First Address | Brighton, MI 48114-7333 |
Second Address | Brighton, MI 48114-7333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 05/05/2009 |