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Individual

KEVIN GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
10763 SW GREENBURG RD, TIGARD, OR 97223-5492
(503) 684-8159
Mailing address
6601 NE 78TH CT STE A3, PORTLAND, OR 97218-2823
(503) 917-3617

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
201400138LPN
OR

Other

Enumeration date
02/22/2018
Last updated
11/07/2019
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