Doctor Name: | MR. HENRY R. GRAY |
NPI Number: | 1033557111 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 503 Ocean Front Walk Venice, CA - 902912403 |
Business Phone Number: | 3103923070 |
Business Fax Number: | |
Mailing Address: | 531 N Hollywood Way # A266, BURBANK |
State: | CA |
Postal Code: | 915054977 |
Phone Number: | 8186939052 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2013 |
NPI Last Update Date: | 12/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |