Active NPI
Kenton Andrew Gray, BS, MC, LPC
- Mental Health Counselor
- Boise, ID
National Provider Identifier
1194049916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-3735
- Practice address
- 6731 N Waterlilly Way
Boise, ID 83714-4043 - Phone
- (208) 608-9132
- NPI assigned
- Mar 23, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-3735 | ID | Primary |
| Professional Counselor | 101YP2500X | LPC-3735 | ID |
Addresses
Primary practice location
6731 N Waterlilly Way
Boise, ID 83714-4043
Mailing address
6731 N Waterlilly Ave
Boise, ID 83714
Phone (208) 608-9132
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-3735 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269302400000",
"number": "1194049916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6731 N WATERLILLY AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "83714",
"telephone_number": "208-608-9132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6731 N WATERLILLY WAY",
"city": "BOISE",
"state": "ID",
"postal_code": "837144043",
"telephone_number": "208-608-9132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "KENTON",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"credential": "BS, MC, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-23",
"last_updated": "2010-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LPC-3735",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-3735",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.