Doctor Name: | DR. ALISE ELIZABETH GRAY |
NPI Number: | 1477994044 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D, |
License Number: | 2014001337 |
Business Practice Address: | 402b W Mount Vernon St #337 Nixa, MO - 657147185 |
Business Phone Number: | 6604920635 |
Business Fax Number: | |
Mailing Address: | 402b W Mount Vernon St, #337 NIXA |
State: | MO |
Postal Code: | 657147185 |
Phone Number: | 6604920635 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2013 |
NPI Last Update Date: | 03/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2014001337 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |