Active NPI
Breona Gray
- Professional Counselor
- Winter Haven, FL
National Provider Identifier
1114379526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC16433
- Practice address
- 511 Highfin Dr
Winter Haven, FL 33881-9412 - Phone
- (443) 599-9524
- NPI assigned
- Jul 9, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LC16433 | NJ | |
| Professional Counselor | 101YP2500X | 6401225281 | MI | |
| Professional Counselor | 101YP2500X | LC16433 | MD | Primary |
Addresses
Primary practice location
511 Highfin Dr
Winter Haven, FL 33881-9412
Mailing address
7901 4TH St N Ste 300
St Petersburg, FL 33702-4399
Phone (443) 599-9524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC16433 | MD | MD | Professional Counselor |
| 6401225281 | MI | MD | Professional Counselor |
| LC16433 | NJ | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Imperial Mentoring, LLC | Past | Accepting new patients | |
| Imperial Mentoring | Past | Accepting new patients | |
| Imperial Mentoring | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Linthicum Heights, MD
- NPI 1154009876
-
- Community/Behavioral Health Agency
- Linthicum Heights, MD
- NPI 1396525291
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- White Plains, MD
- NPI 1407594344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1114379526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7901 4TH ST N STE 300",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337024399",
"telephone_number": "443-599-9524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 HIGHFIN DR",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338819412",
"telephone_number": "443-599-9524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "BREONA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-09",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "LC16433",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401225281",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC16433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.