Provider Demographics
NPI:1053535955
Name:GRAY, ALEXANDER STEWART (MA)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:STEWART
Last Name:GRAY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2013
Mailing Address - Country:US
Mailing Address - Phone:402-453-5656
Mailing Address - Fax:402-455-1811
Practice Address - Street 1:2808 N 75TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6861
Practice Address - Country:US
Practice Address - Phone:402-932-2248
Practice Address - Fax:402-455-1811
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health