Provider Demographics
NPI:1528464534
Name:GRAY, EMILY
Entity type:Individual
Prefix:MS
First Name:EMILY
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 1:652 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2622
Mailing Address - Country:US
Mailing Address - Phone:650-323-1401
Mailing Address - Fax:650-323-1720
Practice Address - Street 1:652 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2622
Practice Address - Country:US
Practice Address - Phone:650-323-1401
Practice Address - Fax:650-323-1720
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881813350Medicaid