Individual provider Active NPI

Holly Crystal Gray, LLMSW

  • Social Worker
  • Grand Rapids, MI
National Provider Identifier
1730565011
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801098515 Issued in MI
Practice address
3300 36TH St SE
Grand Rapids, MI 49512-2810
Phone
(616) 942-2110
NPI assigned
Aug 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801098515 MI Primary

Addresses

Primary practice location

3300 36TH St SE
Grand Rapids, MI 49512-2810

Mailing address

3300 36TH St SE
Grand Rapids, MI 49512-2810
Phone (616) 942-2110

Other names 1

  • Holly Crystal Stratton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220419000200 MI Practitioner - Clinical Social Worker 2264829415 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801098515MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services Social Worker CurrentSince Apr 4, 2022 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Apr 4, 2022 Accepting new patients

Locations

1530 Nichols Rd
Kalamazoo, MI 49006
Phone (269) 343-6700

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1730565011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 36TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122810",
            "telephone_number": "616-942-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 36TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122810",
            "telephone_number": "616-942-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "HOLLY",
        "middle_name": "CRYSTAL",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-10",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801098515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "STRATTON",
            "middle_name": "CRYSTAL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.