Provider Demographics
NPI:1720499106
Name:GRAY, JOHN TRENT (MA, LMHC, SUDP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TRENT
Last Name:GRAY
Suffix:
Gender:M
Credentials:MA, LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8059 SE NELSON RD
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359
Mailing Address - Country:US
Mailing Address - Phone:360-801-2432
Mailing Address - Fax:
Practice Address - Street 1:8059 SE NELSON RD
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359
Practice Address - Country:US
Practice Address - Phone:360-801-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60202770101YA0400X
WA61024115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)