Healthcare Provider Details

I. General information

NPI: 1417862509
Provider Name (Legal Business Name): LITTLE BEAR PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 ARAPAHOE AVE
BOULDER CO
80302-6720
US

IV. Provider business mailing address

2525 ARAPAHOE AVE., UNIT E4, PMB 1298
BOULDER CO
80302
US

V. Phone/Fax

Practice location:
  • Phone: 303-532-1763
  • Fax:
Mailing address:
  • Phone: 303-532-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN GRAY
Title or Position: OWNER/FOUNDER
Credential: PHD
Phone: 303-532-1763