Provider Demographics
NPI:1932937240
Name:GRAY, ADRIA SUSANNE (BHWC)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:SUSANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:BHWC
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 60189
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73146-0189
Mailing Address - Country:US
Mailing Address - Phone:918-636-3474
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 60189
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73146-0189
Practice Address - Country:US
Practice Address - Phone:918-636-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7803171400000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No175T00000XOther Service ProvidersPeer Specialist