Provider Demographics
NPI:1275378358
Name:GRAY, LAURA E (LPC, NCC, PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC, NCC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S INDUSTRY WAY STE 45
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7907
Mailing Address - Country:US
Mailing Address - Phone:208-922-2207
Mailing Address - Fax:208-922-4168
Practice Address - Street 1:690 S INDUSTRY WAY STE 45
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7907
Practice Address - Country:US
Practice Address - Phone:208-922-2207
Practice Address - Fax:208-922-4168
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5861862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional