Individual
BOBBY GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2080 S E ST, SAN BERNARDINO, CA 92408-2706
(909) 388-9191
Mailing address
2225 PUMALO ST APT 322, SAN BERNARDINO, CA 92404-7528
(909) 534-5297
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124100383
—
CA
Enumeration date
09/20/2010
Last updated
09/20/2010
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