Individual
MARY M GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1121 OLIVETTE EXECUTIVE PKWY STE 205, SAINT LOUIS, MO 63132-3254
(314) 991-9058
(314) 993-2050
Mailing address
841 N KIRKWOOD RD, SAINT LOUIS, MO 63122-2639
(360) 628-8612
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2017041035
MO
1041C0700X
Clinical Social Worker
Primary
2020038785
MO
Other
Enumeration date
10/30/2018
Last updated
02/01/2021
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