Provider Demographics
NPI:1487398582
Name:GRAY, ELIZABETH LOUISE (ACMHC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:GRAY
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W 840 S
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4254
Mailing Address - Country:US
Mailing Address - Phone:435-850-9843
Mailing Address - Fax:
Practice Address - Street 1:9140 S STATE ST STE 101-20
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2684
Practice Address - Country:US
Practice Address - Phone:801-341-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11856484-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health