Individual
DR. JILL MAVEN GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
4201 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-4728
(952) 933-8900
(952) 945-9536
Mailing address
4201 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-4728
(952) 933-8900
(952) 945-9536
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3557
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61-56740
MEDICA - UBH
MN
05
—
920215300
—
MN
01
—
996N6AJ
BLUE CROSS/BS
MN
Enumeration date
09/16/2006
Last updated
04/25/2022
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