Provider Demographics
NPI:1699248757
Name:GRAY, LEAH MARIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S BARSTOW ST STE 117
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2618
Mailing Address - Country:US
Mailing Address - Phone:715-229-5809
Mailing Address - Fax:
Practice Address - Street 1:515 S BARSTOW ST STE 117
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2618
Practice Address - Country:US
Practice Address - Phone:715-229-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional