Basic Information
| Provider Information | |||||||||
| NPI: | 1437383452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 GRAND RIVER RD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102202787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7600 GRAND RIVER RD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102202787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 05/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6301009281 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103K00000X | 6301009281 | MI | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103TB0200X | 6301009281 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TM1800X | 6301009281 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103TR0400X | 6301009281 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
No ID Information.