Basic Information
| Provider Information | |||||||||
| NPI: | 1356571467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | MARY MONICA | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | NUNN DRIVE, UC 440 | ||||||||
| Address2: | HEALTH COUNSELING AND STUDENT WELLNESS | ||||||||
| City: | HIGHLAND HEIGHTS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595725650 | ||||||||
| FaxNumber: | 8595725615 | ||||||||
| Practice Location | |||||||||
| Address1: | NUNN DRIVE, UC 440 | ||||||||
| Address2: | HEALTH COUNSELING AND STUDENT WELLNESS | ||||||||
| City: | HIGHLAND HEIGHTS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595725650 | ||||||||
| FaxNumber: | 8595725615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 106468 | KY | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1790731081 | 05 | KY | MEDICAID |