Organization Active NPI

Stefanie a. Gray, PH.D.

  • Clinical Psychologist
  • San Antonio, TX
National Provider Identifier
1013489277
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
STEFANIE A. GRAY, PH.D.
Practice address
132 Princess Pass
San Antonio, TX 78212-5337
Phone
(210) 570-2454
Fax
(210) 966-8959
NPI assigned
Dec 27, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stefanie A. Gray, PH.D.NPI 1730698903
Title
Sole Member
Phone
(210) 570-2454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

132 Princess Pass
San Antonio, TX 78212-5337

Mailing address

132 Princess Pass
San Antonio, TX 78212-5337
Phone (210) 570-2454

Other identifiers 1

IdentifierTypeStateIssuer
14304738OtherCAQH ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190208000189 TX Part B Supplier - Clinic/Group Practice 6002154531 Receives reassigned benefits from 1 practitioner
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

8231 Fredericksburg Rd
San Antonio, TX 78229
Phone (210) 216-5818

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1013489277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 PRINCESS PASS",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782125337",
            "telephone_number": "210-570-2454",
            "fax_number": "210-966-8959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 PRINCESS PASS",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782125337",
            "telephone_number": "210-570-2454",
            "fax_number": "210-966-8959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEFANIE A. GRAY, PH.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-27",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "210-570-2454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "14304738",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.