Provider Demographics
NPI:1477927846
Name:GREY PSYCHOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:GREY PSYCHOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-260-8785
Mailing Address - Street 1:3569 W FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9046
Mailing Address - Country:US
Mailing Address - Phone:415-260-8785
Mailing Address - Fax:
Practice Address - Street 1:1821 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5352
Practice Address - Country:US
Practice Address - Phone:415-260-8785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202856103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty