MEDICARE: CHRISTOPHER L GRAY MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2836	CO

General Provider Information

NPI Number	:	1952635567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER L GRAY MA

Provider Business Mailing Address
First Line	:	345 E 27TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3203
Country	:	US
Telephone Number	:	970-669-2370
Fax Number	:	970-669-2790

Provider Business Practice Location Address
First Line	:	345 E 27TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3203
Country	:	US
Telephone Number	:	970-669-2370
Fax Number	:	970-669-2790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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