Individual
MR. ROGER D. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
605 E 12TH ST, ADA, OK 74820-6605
(580) 436-3504
(580) 436-5047
Mailing address
PO BOX 2274, ADA, OK 74821-2274
(580) 436-3504
(580) 436-5047
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
112
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100633110C
—
OK
Enumeration date
08/19/2008
Last updated
08/19/2008
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