Provider Demographics
NPI:1417022625
Name:GRAY, BERNADETTE JEANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:JEANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22793 E DAVIES DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2384
Mailing Address - Country:US
Mailing Address - Phone:303-317-5472
Mailing Address - Fax:303-317-5270
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:B-12
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2758
Practice Address - Country:US
Practice Address - Phone:303-317-5472
Practice Address - Fax:303-317-5270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional