Provider Demographics
NPI:1699927459
Name:GREY, KYM G (LCSW)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:G
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92079
Mailing Address - Country:US
Mailing Address - Phone:760-908-7165
Mailing Address - Fax:
Practice Address - Street 1:1300 RANCHO DEL ORO RD.
Practice Address - Street 2:SUITE 1J-1I3
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-643-2086
Practice Address - Fax:760-643-2096
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical