Samuel Clyde Gray, MA, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH 11620 Issued in FL

Practice address

2523 US Highway 27 S
Suite 130
Avon Park, FL 33825-7744

Phone

(863) 452-0710

NPI assigned

Feb 28, 2013

Last updated

Feb 28, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1467792317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COUNTY ROAD 17A N",
            "address_2": "LOT 64",
            "city": "AVON PARK",
            "state": "FL",
            "postal_code": "338257739",
            "telephone_number": "863-257-2533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2523 US HIGHWAY 27 S",
            "address_2": "SUITE 130",
            "city": "AVON PARK",
            "state": "FL",
            "postal_code": "338257744",
            "telephone_number": "863-452-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "SAMUEL",
        "middle_name": "CLYDE",
        "credential": "MA, LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 11620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Gomara, DMD
• Araceli Gomez, LCSW
• Joshua Tremaine Gordon
• Tammy J Grant, LMT
• Olivia Gray
• Jacalyn Ann Griffin, OTR/L
• Guardian Angels Services LLC
• Health Holdings Company LLC (Palm Medical Centers)
• Heartland Behavioral Homes LLC
• Heavens Angels Services LLC

• Mental Health Counselor in Avon Park, FL
• Providers in Avon Park, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.