Provider Demographics
NPI:1770002305
Name:GRAY, PATRICK LANDON (BCBA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LANDON
Last Name:GRAY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2218
Mailing Address - Country:US
Mailing Address - Phone:719-466-4809
Mailing Address - Fax:
Practice Address - Street 1:12650 E BRIARWOOD AVE UNIT 207
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6792
Practice Address - Country:US
Practice Address - Phone:720-470-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician