Individual
LAURENCE BURTON GRAY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 N BROADWAY ST, MOORE, OK 73160-4812
(405) 735-4650
Mailing address
400 N BROADWAY ST, MOORE, OK 73160-4812
(405) 735-4650
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-0419474
OKLAHOMA FAMILY COUNSELING
OK
Enumeration date
08/21/2015
Last updated
08/21/2015
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