Provider Demographics
NPI:1073279766
Name:GRAY, SAVANNA
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:GRAY
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 1:8510 BRYANT ST STE 360
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3852
Mailing Address - Country:US
Mailing Address - Phone:720-798-6572
Mailing Address - Fax:
Practice Address - Street 1:8510 BRYANT ST STE 360
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3852
Practice Address - Country:US
Practice Address - Phone:720-798-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician