Provider Demographics
NPI:1316291297
Name:GRAY, AMANDA P (LPCS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:P
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:A
Other - Last Name:PASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NBCC
Mailing Address - Street 1:1401 SANDIA PLZ
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4356
Mailing Address - Country:US
Mailing Address - Phone:512-650-9252
Mailing Address - Fax:979-859-7226
Practice Address - Street 1:1401 SANDIA PLZ
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4356
Practice Address - Country:US
Practice Address - Phone:512-650-9252
Practice Address - Fax:979-859-7226
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67715OtherTSBEC