Individual provider Active NPI

Jennifer Gray, PH.D.

  • Psychologist
  • Fort Collins, CO
National Provider Identifier
1194788414
Registry record updated Nov 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2280 Issued in CO
Practice address
300 Boardwalk Dr
BLDG 5a
Fort Collins, CO 80525-3070
Phone
(970) 223-2256
Fax
(970) 223-2324
NPI assigned
Apr 8, 2006
Last updated
Nov 8, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2280 CO Primary
Clinical Child & Adolescent Psychologist 103TC2200X 2280 CO

Addresses

Primary practice location

300 Boardwalk Dr
BLDG 5a
Fort Collins, CO 80525-3070

Mailing address

300 Boardwalk Dr
BLDG 5a
Fort Collins, CO 80525-3070
Phone (970) 223-2256

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2280COMDMedical Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289174400000",
    "number": "1194788414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 BOARDWALK DR",
            "address_2": "BLDG 5A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253070",
            "telephone_number": "970-223-2256",
            "fax_number": "970-223-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BOARDWALK DR",
            "address_2": "BLDG 5A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253070",
            "telephone_number": "970-223-2256",
            "fax_number": "970-223-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JENNIFER",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-08",
        "last_updated": "2010-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "2280",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CO",
            "license": "2280",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.