Active NPI
Kristin Lynn Gray, PSYD
- Clinical Psychologist
- Covina, CA
National Provider Identifier
1336420769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 29948
- Practice address
- 1359 N Grand Ave
Covina, CA 91724-1016 - Phone
- (626) 430-2900
- NPI assigned
- Aug 30, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | 29948 | CA | Primary |
Addresses
Primary practice location
1359 N Grand Ave
Covina, CA 91724-1016
Mailing address
PO Box 1155
Azusa, CA 91702-1155
Other practice location 1
902 S Myrtle Ave
Monrovia, CA 91016-3427
Phone (626) 357-3258
Other practice location 2
1460 N Lake Ave Ste 101
Pasadena, CA 91104
Phone (626) 296-7710
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576627200000",
"number": "1336420769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1155",
"city": "AZUSA",
"state": "CA",
"postal_code": "917021155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1359 N GRAND AVE",
"city": "COVINA",
"state": "CA",
"postal_code": "917241016",
"telephone_number": "626-430-2900"
}
],
"practiceLocations": [
{
"address_1": "902 S Myrtle Ave",
"address_purpose": "LOCATION",
"city": "Monrovia",
"state": "CA",
"postal_code": "910163427",
"country_code": "US",
"telephone_number": "626-357-3258",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1460 N Lake Ave Ste 101",
"address_purpose": "LOCATION",
"city": "Pasadena",
"state": "CA",
"postal_code": "91104",
"country_code": "US",
"telephone_number": "626-296-7710",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAY",
"first_name": "KRISTIN",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-30",
"last_updated": "2019-12-18",
"certification_date": "2019-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29948",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.