Provider Demographics
NPI:1306126305
Name:GRAY, SANDRA
Entity type:Individual
Prefix:MRS
First Name:SANDRA
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 1:4312 THOM BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2715
Mailing Address - Country:US
Mailing Address - Phone:702-541-3563
Mailing Address - Fax:
Practice Address - Street 1:2340 PASEO DEL PRADO STE D305
Practice Address - Street 2:LAS VEGAS
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4342
Practice Address - Country:US
Practice Address - Phone:877-604-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health