Provider Demographics
NPI:1588417182
Name:GRAY, KRISTA (LPC-MHSP (TEMP))
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 MABEL DR APT 5206
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3699
Mailing Address - Country:US
Mailing Address - Phone:615-410-0446
Mailing Address - Fax:615-410-0446
Practice Address - Street 1:357 RIVERSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5448
Practice Address - Country:US
Practice Address - Phone:615-200-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6459101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health