Individual
ELIZABETH GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QBHP
Contact information
Practice address
1004 S MAIN ST, BERRYVILLE, AR 72616-4330
(870) 423-1077
Mailing address
4171 N CROSSOVER RD, FAYETTEVILLE, AR 72703-4591
(479) 521-1427
(479) 521-6520
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195097795
—
AR
Enumeration date
01/23/2013
Last updated
07/13/2020
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