Individual
SAMMY G GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
4900 W ACORN RD, TISHOMINGO, OK 73460-4801
(580) 220-5850
Mailing address
4900 W ACORN RD, TISHOMINGO, OK 73460-4801
(580) 220-5850
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/12/2010
Last updated
01/12/2010
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