Colleen Gray Klabo, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-202666 Issued in ID

Practice address

2076 S Eagle Rd
Meridian, ID 83642-6707

Phone

(208) 955-7340

NPI assigned

Feb 14, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Colleen Elizabeth Gray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Neurobehavioral Health PLLC

  • Clinical Psychologist
  • Boise, ID
  • NPI 1518102797
  NPD (past)

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366934400000",
    "number": "1679741490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 W CAMEL BACK LN",
            "address_2": "#127",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026567",
            "telephone_number": "206-817-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2076 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426707",
            "telephone_number": "208-955-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLABO",
        "first_name": "COLLEEN",
        "middle_name": "GRAY",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-14",
        "last_updated": "2013-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY-202666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679741490",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "GRAY",
            "middle_name": "ELIZABETH",
            "credential": "MA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Claire Kiota
• Bryce Jacob Kirkman, D.O.
• Savannah Kisling- Scrima, PT, DPT
• Brian Craig Kitamura, M.D.
• Brian Dennis Kittelson, DNP, ARNP, FNP-C
• Vanessa M Klaus, FNP
• Kimberly A Kleaveland, FNP
• Eric W Klein, M.D.,MPH, TM
• Kelly Marie Klinger, COTA/L
• Jack D Klure, DDS

• Psychologist in Meridian, ID
• Providers in Meridian, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2013; 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.