Provider Demographics
NPI:1467324251
Name:GRAY, MICHELLE NICOLE (LCSW-S)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10123 MESCALERO CANYON LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6913
Mailing Address - Country:US
Mailing Address - Phone:317-289-9809
Mailing Address - Fax:
Practice Address - Street 1:4703 W 30TH ST # 1026
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1513
Practice Address - Country:US
Practice Address - Phone:317-289-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043261041C0700X
IN34006891A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical