Glenn Edward Gray Jr., LCSW
Individual provider Active NPI Clinical Social Worker · Aquilla, TX
NPI 1992938146 · NPPES record last updated Sep 3, 2009
Key facts
- NPI
- 1992938146
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 11478 (TX)
- Practice address
- 539 HC 2122 W
Aquilla, TX 76622-2495 - Phone
- (254) 205-0993
- NPI assigned
- Sep 3, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11478 | TX | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11478 | TX | Yes |
Addresses
Primary practice location
539 HC 2122 W
Aquilla, TX 76622-2495
Mailing address
539 HC 2122 W
Aquilla, TX 76622-2495
Phone (254) 205-0993
Other providers in Aquilla, TX
- Aquilla Isd
- Backroads Therapy LLC
- Clear Springs Healthcare LLC
- Brittany Harrison
- Leslie Elizabeth Hunt
All providers in Aquilla, TX · Clinical Social Worker in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.