Basic Information
Provider Information
NPI: 1154636116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGREW
FirstName: ELAINA
MiddleName: MARIEL
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1439 LIPAN ST
Address2:  
City: DENVER
State: CO
PostalCode: 802042532
CountryCode: US
TelephoneNumber: 3033944386
FaxNumber: 3033360966
Practice Location
Address1: 793 OLIVE ST
Address2:  
City: DENVER
State: CO
PostalCode: 802205552
CountryCode: US
TelephoneNumber: 3033944386
FaxNumber: 3033360966
Other Information
ProviderEnumerationDate: 08/16/2010
LastUpdateDate: 06/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home