Provider Demographics
NPI:1366707481
Name:GRAY, LOUIS G I
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:G
Last Name:GRAY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 RAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-1638
Mailing Address - Country:US
Mailing Address - Phone:918-336-4073
Mailing Address - Fax:
Practice Address - Street 1:1011 GRANDVIEW
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056
Practice Address - Country:US
Practice Address - Phone:918-287-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)