Gray-Couch, James Russell

Gray-Couch, James Russell is an individual health care provider with primary practice located at 348 Enterprise Dr Ste B , Valdosta GA 31601-5169. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Gray-Couch, James Russell can be contacted via phone (229) 293-0132.

Contact Information

Primary practice address
348 Enterprise Dr Ste B Valdosta GA 31601-5169
Phone: (229) 293-0132
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 68-019393 New York
Behavioral Health & Social Service Providers / Clinical 103TC0700X 0810007761 Virginia

Profile Details

NPI number 1619171618
LBN Legal business name Gray-Couch, James Russell
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2007
Last updated Feb 25th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619171618 NPPES
Kentucky MEDICAID 30610026

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