Provider Demographics
NPI:1780778290
Name:MEYER, GRATIA L (PHD)
Entity type:Individual
Prefix:DR
First Name:GRATIA
Middle Name:L
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6053 S QUEBEC ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4503
Mailing Address - Country:US
Mailing Address - Phone:303-779-5232
Mailing Address - Fax:303-221-8493
Practice Address - Street 1:6053 S QUEBEC ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4503
Practice Address - Country:US
Practice Address - Phone:303-779-5232
Practice Address - Fax:303-221-8493
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07106834Medicaid