Healthcare Provider Details

I. General information

NPI: 1467138131
Provider Name (Legal Business Name): JAMES MACGREGOR ANTHONY GRAY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4869 BROADWAY ST
BOULDER CO
80304-0523
US

IV. Provider business mailing address

4869 BROADWAY ST
BOULDER CO
80304-0523
US

V. Phone/Fax

Practice location:
  • Phone: 303-617-2300
  • Fax:
Mailing address:
  • Phone: 804-370-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW.09932808
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: