Individual
MR. STANFORD J GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2909 KING ST STE A, JONESBORO, AR 72401-5326
(870) 351-5020
Mailing address
2909 KING ST STE A, JONESBORO, AR 72401-5326
(870) 351-5020
(870) 382-3025
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
1979-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171752795
—
AR
01
—
5Y583
BLUE CROSS NUMBER
AR
Enumeration date
06/15/2006
Last updated
03/10/2019
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