| Kendra Gray Phd Plc | |
|
109 N Main St Henderson KY 42420-3101 | |
| (812) 491-1307 | |
| (270) 495-4284 |
| Full Name | Kendra Gray Phd Plc |
|---|---|
| Speciality | Psychologist |
| Location | 109 N Main St, Henderson, Kentucky |
| Authorized Official Name and Position | Kendra M Gray (MEMBER) |
| Authorized Official Contact | 2709848140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kendra Gray Phd Plc Po Box 3276 Evansville IN 47731-3276 Ph: (812) 473-0181 | Kendra Gray Phd Plc 109 N Main St Henderson KY 42420-3101 Ph: (812) 491-1307 |
| NPI Number | 1730554767 |
|---|---|
| Provider Enumeration Date | 12/02/2015 |
| Last Update Date | 11/09/2020 |
| Certification Date | 11/09/2020 |
| Medicare PECOS PAC ID | 7810290079 |
|---|---|
| Medicare Enrollment ID | O20160121000845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730554767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1752 (Kentucky) | Primary |
| Provider Name | Kendra M Gray |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861578171 PECOS PAC ID: 7113156936 Enrollment ID: I20140127001165 |
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