Provider Demographics
NPI:1043889447
Name:GRAY, KATLYN CHEREE (LMSW)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:CHEREE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:CHEREE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4812 UNION PARK BLVD E
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1528
Mailing Address - Country:US
Mailing Address - Phone:469-540-8200
Mailing Address - Fax:
Practice Address - Street 1:6950 SHADY LN
Practice Address - Street 2:
Practice Address - City:SCURRY
Practice Address - State:TX
Practice Address - Zip Code:75158-2831
Practice Address - Country:US
Practice Address - Phone:469-721-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical