Provider Demographics
NPI:1033864269
Name:GARAY, PRISCILLA
Entity Type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:
Last Name:GARAY
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:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0331
Mailing Address - Country:US
Mailing Address - Phone:719-342-1411
Mailing Address - Fax:
Practice Address - Street 1:440 ROAD 28
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:KS
Practice Address - Zip Code:67761-3030
Practice Address - Country:US
Practice Address - Phone:303-406-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO968257669OtherUNITEDHEALTHCARE