Provider Demographics
NPI:1720829955
Name:GRAY, CYNTHIA ANNE
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANNE
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 1:472 OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-6525
Mailing Address - Country:US
Mailing Address - Phone:931-434-0046
Mailing Address - Fax:
Practice Address - Street 1:1520 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2520
Practice Address - Country:US
Practice Address - Phone:931-434-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral