Provider Demographics
NPI:1124500301
Name:EMILY K. GRAY, MFT, INC.
Entity type:Organization
Organization Name:EMILY K. GRAY, MFT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:352-225-3360
Mailing Address - Street 1:3615 NW 13TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2187
Mailing Address - Country:US
Mailing Address - Phone:352-225-3360
Mailing Address - Fax:
Practice Address - Street 1:3615 NW 13TH ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2187
Practice Address - Country:US
Practice Address - Phone:352-225-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3524103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty