Individual
KIMBERLY JEAN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC, CM
Contact information
Practice address
66 CLUB RD STE 160, EUGENE, OR 97401-2439
(541) 345-1722
(541) 485-7049
Mailing address
PO BOX 70779, SPRINGFIELD, OR 97475-0137
(541) 345-1722
(541) 485-7049
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
21-QMHP-R-0833
OR
101YP2500X
Professional Counselor
3893
OK
101YP2500X
Professional Counselor
Primary
C6574
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12140003
CAQH ID
—
05
—
3893
—
OK
05
—
500796814
—
OR
Enumeration date
02/13/2007
Last updated
12/28/2023
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