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

Table of content: ANJUMUNARA KHANOM RN (NPI 1407655665)

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

Authorized Official Last Name:
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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".