Provider Demographics
NPI:1871950048
Name:GRAY, TEMORA (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:TEMORA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 AVONDALE PARK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0357
Mailing Address - Country:US
Mailing Address - Phone:917-783-8065
Mailing Address - Fax:800-383-9015
Practice Address - Street 1:9303 AVONDALE PARK
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-0357
Practice Address - Country:US
Practice Address - Phone:917-783-8065
Practice Address - Fax:800-383-9015
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-19471103K00000X
TX37702103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405456102Medicaid