| Doctor Name: | SAMUEL CLYDE GRAY |
| NPI Number: | 1467792317 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LMHC |
| License Number: | MH 11620 |
| Business Practice Address: | 2523 Us Highway 27 S Suite 130 Avon Park, FL - 338257744 |
| Business Phone Number: | 8634520710 |
| Business Fax Number: | |
| Mailing Address: | 1400 County Road 17a N, Lot 64 AVON PARK |
| State: | FL |
| Postal Code: | 338257739 |
| Phone Number: | 8632572533 |
| Fax Number: | |
| NPI Enumeration Date: | 02/28/2013 |
| NPI Last Update Date: | 02/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH 11620 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |