Individual
STACEY GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPC
Contact information
Practice address
6628 SKY POINTE DR STE 115, LAS VEGAS, NV 89131-4071
(702) 620-9354
(702) 935-8945
Mailing address
2542 SUNGOLD DR, LAS VEGAS, NV 89134-8890
(702) 569-1917
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CP1185
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI0118
STATE LICENSE
NV
Enumeration date
08/19/2014
Last updated
05/21/2021
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