Individual
MR. KENTON ANDREW GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS, MC, LPC
Contact information
Practice address
6731 N WATERLILLY WAY, BOISE, ID 83714-4043
(208) 608-9132
Mailing address
6731 N WATERLILLY AVE, BOISE, ID 83714
(208) 608-9132
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-3735
ID
101YP2500X
Professional Counselor
LPC-3735
ID
Other
Enumeration date
03/23/2010
Last updated
03/23/2010
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