Michelle Dereschuk Gray, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3096 Issued in AZ

Practice address

1515 N San Francisco St
Flagstaff, AZ 86001-1435

Phone

(928) 774-3400

NPI assigned

May 16, 2007

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 names 1

• Dr. Michelle Dereschuk Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2023 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234483200000",
    "number": "1942417696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2456",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860032456",
            "telephone_number": "928-774-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N SAN FRANCISCO ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011435",
            "telephone_number": "928-774-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "MICHELLE",
        "middle_name": "DERESCHUK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2009-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "3096",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "AZ",
            "license": "LMFT0324",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "DERESCHUK",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kendra Grathwohl, MD
• David S Grauman, M.D., P.C., M.R.O.
• Lauren Graves
• Joseph M Gray
• Laurel S. Gray, MD, MS
• John Paul Graziano, M.D.
• Kyler Green, RBT
• Nathaniel Green, PHARMD
• Peter Gerard Green, DDS
• Zachary Tyler Green, OD

• Psychologist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.