Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CO |
NPI | 1003204207 |
---|---|
Provider Name | Maura Phillips Gray |
First Address | Colorado Springs, CO 80906-4651 |
Second Address | Colorado Springs, CO 80909-1679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 20/07/2020 |