MEDICARE: MS. JODY R MCCRAY

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1659859668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODY R MCCRAY

Provider Business Mailing Address
First Line	:	4554 EUREKA CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5140
Country	:	US
Telephone Number	:	303-371-1968
Fax Number	:

Provider Business Practice Location Address
First Line	:	4554 EUREKA CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5140
Country	:	US
Telephone Number	:	303-371-1968
Fax Number	:

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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