Provider Demographics
NPI:1154698512
Name:GRATIA L. MEYER, PHD LLC
Entity type:Organization
Organization Name:GRATIA L. MEYER, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRATIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-779-5232
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:SUITE B-13
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2744
Mailing Address - Country:US
Mailing Address - Phone:303-779-5232
Mailing Address - Fax:303-221-8493
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:SUITE B-13
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2744
Practice Address - Country:US
Practice Address - Phone:303-779-5232
Practice Address - Fax:303-221-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1661305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization