Provider Demographics
NPI:1073579637
Name:GRGICH, BECKIE M (PSYD, PSY)
Entity Type:Individual
Prefix:
First Name:BECKIE
Middle Name:M
Last Name:GRGICH
Suffix:
Gender:F
Credentials:PSYD, PSY
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 3392
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3392
Mailing Address - Country:US
Mailing Address - Phone:719-344-8779
Mailing Address - Fax:719-313-9210
Practice Address - Street 1:14960 WOODCARVER RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2370
Practice Address - Country:US
Practice Address - Phone:193-448-7797
Practice Address - Fax:193-139-2107
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4845018-2501103T00000X
NVP40413103T00000X
FL6176103T00000X
CO3041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502768Medicaid
NV38760Medicare ID - Type Unspecified