Provider Demographics
NPI:1023812427
Name:GRAY, PHILIP BRADLEY
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:BRADLEY
Last Name:GRAY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N CHEROKEE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5599
Mailing Address - Country:US
Mailing Address - Phone:423-262-0180
Mailing Address - Fax:
Practice Address - Street 1:501 N CHEROKEE ST STE 2
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5599
Practice Address - Country:US
Practice Address - Phone:423-262-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health