Provider Demographics
NPI:1124299953
Name:GRAY, DAVID F (PCC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:GRAY
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14504 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5941
Mailing Address - Country:US
Mailing Address - Phone:216-258-2930
Mailing Address - Fax:
Practice Address - Street 1:14538 GRAPELAND AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2107
Practice Address - Country:US
Practice Address - Phone:216-252-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0008341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health