Provider Demographics
NPI:1487976452
Name:GRAY, JONATHAN (LPC, LAC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 E GIRARD AVE
Mailing Address - Street 2:D-218
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5633
Mailing Address - Country:US
Mailing Address - Phone:720-773-1264
Mailing Address - Fax:
Practice Address - Street 1:10200 E GIRARD AVE
Practice Address - Street 2:D-218
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5633
Practice Address - Country:US
Practice Address - Phone:720-773-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO871101YA0400X
CO4488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)