1609904523 NPI number — CATHERINE DALE GRAY MFT

Table of content: CATHERINE DALE GRAY MFT (NPI 1609904523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609904523 NPI number — CATHERINE DALE GRAY MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
CATHERINE
Provider Middle Name:
DALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAY
Provider Other First Name:
DALE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609904523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4338 LORETO LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-7500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-688-1600
Provider Business Mailing Address Fax Number:
775-688-1616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2655 ENTERPRISE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89512-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-688-1600
Provider Business Practice Location Address Fax Number:
775-688-1616
Provider Enumeration Date:
03/01/2007

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: 106H00000X , with the licence number:  0768 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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