1609531987 NPI number — AUDREY LAYNE GRAY LLPC

Table of content: AUDREY LAYNE GRAY LLPC (NPI 1609531987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609531987 NPI number — AUDREY LAYNE GRAY LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
AUDREY
Provider Middle Name:
LAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSTERMILLER
Provider Other First Name:
AUDREY
Provider Other Middle Name:
GRAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609531987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3150 WOODWARD AVE APT 504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-2753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-731-2454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42815 GARFIELD RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-333-5328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6451021929 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)