Provider Demographics
NPI:1104588532
Name:GRAY, CHELSEA
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N. SAM HOUSTON PKWY EAST
Mailing Address - Street 2:STE. 110
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396
Mailing Address - Country:US
Mailing Address - Phone:832-412-1787
Mailing Address - Fax:
Practice Address - Street 1:9240 N. SAM HOUSTON PKWY EAST
Practice Address - Street 2:STE. 110
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396
Practice Address - Country:US
Practice Address - Phone:832-412-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician