Provider Demographics
NPI:1962221077
Name:GRAY, JAMIE ELLEN (LPC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ELLEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18-6 E DUNDEE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7404
Mailing Address - Country:US
Mailing Address - Phone:847-665-8802
Mailing Address - Fax:
Practice Address - Street 1:18-6 E DUNDEE RD STE 160
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7404
Practice Address - Country:US
Practice Address - Phone:847-665-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional