Provider Demographics
NPI:1083404347
Name:GRAY, JASMINE RENEE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENEE
Last Name:GRAY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-8018
Mailing Address - Country:US
Mailing Address - Phone:269-252-1949
Mailing Address - Fax:
Practice Address - Street 1:2142 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-8018
Practice Address - Country:US
Practice Address - Phone:269-252-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor