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NPI Code Detail

MEDICARE: JOHN M. GRAY MA LPC

MEDICARE: JOHN M. GRAY MA LPC
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
1101YP2500XProfessional Counselor1859CO

General Provider Information

NPI Number : 1679781785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN M. GRAY MA LPC
Provider Business Mailing Address
First Line : 1644 S COLLEGE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-1007
Country : US
Telephone Number : 970-221-0999
Fax Number :
Provider Business Practice Location Address
First Line : 1644 S COLLEGE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-1007
Country : US
Telephone Number : 970-221-0999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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Directions to “ JOHN M. GRAY MA LPC” Practice Location

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