Provider Demographics
NPI:1528347846
Name:GRAY, JAMIE MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
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 1:60 HIGHWAY 22 WEST
Mailing Address - Street 2:BLANDY WAY OFFICE PARK
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-6606
Mailing Address - Country:US
Mailing Address - Phone:478-451-2704
Mailing Address - Fax:478-445-1296
Practice Address - Street 1:60 HIGHWAY 22 WEST
Practice Address - Street 2:BLANDY WAY OFFICE PARK
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-6606
Practice Address - Country:US
Practice Address - Phone:478-451-2704
Practice Address - Fax:478-445-1296
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001182OtherLMFT