1760670350 NPI number — Gray's Trauma-Informed Care Services Dr. Amber Deneen Gray LEA, CVIS, CCFDVC, CHTVSP, DAC, DBH

Table of content: Dr. Amber Deneen Gray LEA, CVIS, CCFDVC, CHTVSP, DAC, DBH (NPI 1760670350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760670350 NPI number — Gray's Trauma-Informed Care Services Dr. Amber Deneen Gray LEA, CVIS, CCFDVC, CHTVSP, DAC, DBH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Gray's Trauma-Informed Care Services
Provider Last Name:
Gray
Provider First Name:
Amber
Provider Middle Name:
Deneen
Provider Name Prefix Text:
Dr.
Provider Name Suffix Text:
Provider Credential Text:
LEA, CVIS, CCFDVC, CHTVSP, DAC, DBH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760670350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W. Graham Ave. #1401
Provider Second Line Business Mailing Address:
Gray's Trauma-Informed Care Services - Inquire Dept.
Provider Business Mailing Address City Name:
Lake Elsinore
Provider Business Mailing Address State Name:
Ca
Provider Business Mailing Address Postal Code:
92530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-382-4841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W. Graham Ave. #1401
Provider Second Line Business Practice Location Address:
Gray's Trauma-Informed Care Services
Provider Business Practice Location Address City Name:
Lake Elsinore
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-382-4841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2007

Additional Information

			
		

Authorized Official

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Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Comprehensive Victim Intervention Specialist . This is a "National Organization of Victim Assistance" identifier , issued by the state of ( CA ) . This identifiers is of the category "Credential - N37-048-4108".
  • Identifier: Clinically Certified Forensic Domestic Violence Counselor . This is a "National Association of Forensic Counselors" identifier , issued by the state of ( California ) . This identifiers is of the category "Certification - 28400".
  • Identifier: Certified Human Trafficking Victim Services Provider . This is a "National Association of Forensic Counselors" identifier , issued by the state of ( California ) . This identifiers is of the category "Certification -28400".
  • Identifier: Doctoral Addictions Counselor . This is a "National Association of Forensic Counselors" identifier , issued by the state of ( California ) . This identifiers is of the category "Certification - 28400".
  • Identifier: Security Services and Education . This is a "Bureau of Security & Investigative Services" identifier , issued by the state of ( California ) . This identifiers is of the category "License - G6422193".