Provider Demographics
NPI:1174812648
Name:GRAY, AMY DAWSON (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DAWSON
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 S GRAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2505
Mailing Address - Country:US
Mailing Address - Phone:720-312-7817
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:STE. 301
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:720-312-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health