Provider Demographics
NPI:1437405149
Name:GREY, ERIN KIM
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KIM
Last Name:GREY
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 1:3340 HARRISON BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1200
Mailing Address - Country:US
Mailing Address - Phone:801-393-3113
Mailing Address - Fax:
Practice Address - Street 1:3340 HARRISON BLVD
Practice Address - Street 2:STE 100
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1200
Practice Address - Country:US
Practice Address - Phone:801-393-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist