Individual
MARY ELLEN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9408 B VERMONT COURT, CLOVIS, NM 88101
(850) 543-9607
Mailing address
9408 B VERMONT COURT, CLOVIS, NM 88101
(850) 543-9607
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/29/2016
Last updated
09/11/2017
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