Individual
KELLY B GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1233 W POPLAR ST, ROGERS, AR 72756-4245
(479) 636-9235
(479) 631-0374
Mailing address
614 E EMMA AVE STE 300, SPRINGDALE, AR 72764-4469
(479) 751-7417
(479) 751-4898
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2642-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177258795
—
AR
01
—
5AC40
BCBS
AR
Enumeration date
06/08/2009
Last updated
10/05/2012
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