1952609554 NPI number — MRS. RICA MILLER GRAY LPC, NCC, CRC

Table of content: MRS. RICA MILLER GRAY LPC, NCC, CRC (NPI 1952609554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952609554 NPI number — MRS. RICA MILLER GRAY LPC, NCC, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
RICA
Provider Middle Name:
MILLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952609554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39236-6122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-278-5394
Provider Business Mailing Address Fax Number:
601-362-2815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 I 55 N
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39211-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-278-5394
Provider Business Practice Location Address Fax Number:
601-847-5767
Provider Enumeration Date:
03/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1411 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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