Provider Demographics
NPI:1245376920
Name:GRAY, ELIZABETH A (PHD PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGY
Other - Prefix:DR
Other - First Name:LIBBE
Other - Middle Name:A
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD PSYCHOLOGY
Mailing Address - Street 1:3092 EVERGREEN PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:720-244-0019
Mailing Address - Fax:
Practice Address - Street 1:3092 EVERGREEN PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:720-244-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2695103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling