Provider Demographics
NPI:1942407440
Name:GRAY NEUROPSYCHOLOGY ASSOC PC
Entity Type:Organization
Organization Name:GRAY NEUROPSYCHOLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GARLAND
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-487-1760
Mailing Address - Street 1:18695 SHILOH RANCH DR
Mailing Address - Street 2:STE 20
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908
Mailing Address - Country:US
Mailing Address - Phone:719-487-1760
Mailing Address - Fax:719-487-1755
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:STE 200C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-487-1760
Practice Address - Fax:719-487-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2309103G00000X
TX22735103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty