1538315569 NPI number — ANDREW GRAY LMFT

Table of content: ANDREW GRAY LMFT (NPI 1538315569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538315569 NPI number — ANDREW GRAY LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
ANDREW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538315569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6424 N. 9TH STREET
Provider Second Line Business Mailing Address:
CHILD & FAMILY GUIDANCE CENTER
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-565-4484
Provider Business Mailing Address Fax Number:
253-565-5823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6424 N. 9TH STREET
Provider Second Line Business Practice Location Address:
CHILD & FAMILY GUIDANCE CENTER
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-4484
Provider Business Practice Location Address Fax Number:
253-565-5823
Provider Enumeration Date:
08/11/2008

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:  LF60007032 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LF60007032 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 910598103 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".