Provider Demographics
NPI:1982432795
Name:GAY, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 SIMMS ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6313
Mailing Address - Country:US
Mailing Address - Phone:630-814-9284
Mailing Address - Fax:
Practice Address - Street 1:1935 SIMMS ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6313
Practice Address - Country:US
Practice Address - Phone:630-814-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor