Provider Demographics
NPI:1902106370
Name:GRAY, HEIDI E (LMFT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:E
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 H. STREET
Mailing Address - Street 2:STUDIO 450 #588
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-7414
Mailing Address - Country:US
Mailing Address - Phone:159-063-9394
Mailing Address - Fax:
Practice Address - Street 1:1829 MARKET ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-7414
Practice Address - Country:US
Practice Address - Phone:415-906-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84787106H00000X
INTERN #63600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist