Provider Demographics
NPI:1366779811
Name:ALDRICH GRAY, ERIN MICHELE (MFT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MICHELE
Last Name:ALDRICH GRAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MICHELE
Other - Last Name:ALDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:2700 SAGEBRUSH AVE.
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009
Mailing Address - Country:US
Mailing Address - Phone:307-514-2630
Mailing Address - Fax:
Practice Address - Street 1:3124 OLD FAITHFUL RD.
Practice Address - Street 2:SUITE 110
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-426-4798
Practice Address - Fax:307-426-4799
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPMFT-235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1619097755Medicaid