Provider Demographics
NPI:1053514281
Name:GRAY, STEVEN GARLAND (PHD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GARLAND
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18695 SHILOH RANCH DR
Mailing Address - Street 2:STE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908
Mailing Address - Country:US
Mailing Address - Phone:719-487-1760
Mailing Address - Fax:719-487-1755
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:STE 200C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-487-1760
Practice Address - Fax:719-487-1755
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2309103G00000X
TX22735103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist