Provider Demographics
NPI:1861523128
Name:GRAY, KARIN MARIE (MA LPC CCSOTS)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA LPC CCSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221
Mailing Address - Country:US
Mailing Address - Phone:517-263-0880
Mailing Address - Fax:
Practice Address - Street 1:199 BROAD STREET
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-263-2191
Practice Address - Fax:517-264-6080
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional