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NPI Code Detail

MEDICARE: JAMES MACGREGOR ANTHONY GRAY LCSW

MEDICARE: JAMES MACGREGOR ANTHONY GRAY LCSW
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
1101YM0800XMental Health CounselorCSW.09932808CO

General Provider Information

NPI Number : 1467138131
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES MACGREGOR ANTHONY GRAY LCSW
Provider Business Mailing Address
First Line : 4869 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-0523
Country : US
Telephone Number : 804-370-6539
Fax Number :
Provider Business Practice Location Address
First Line : 4869 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-0523
Country : US
Telephone Number : 303-617-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2023
Last Update Date : 03/18/2026

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