DR. MICHELLE DERESCHUK GRAY PH.D.
NPI 1942417696
Psychologist in Flagstaff, AZ

Active since May 16, 2007Opted out of Medicare · through Oct 1, 2027
1515 N SAN FRANCISCO ST, FLAGSTAFF, AZ 86001(928) 774-3400 Get Directions Write a Review

NPPES record last updated: February 13, 2009. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. Michelle Dereschuk Gray Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHELLE DERESCHUK GRAY PH.D. (NPI 1942417696) is an individual psychologist in Flagstaff, Arizona, licensed in Arizona (3096) and active in the NPI registry since May 2007. She has opted out of Medicare through October 1, 2027.

NPPES Registry Identity

NPI1942417696
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. MICHELLE DERESCHUK GRAYCredential: PH.D.
Location Address1515 N SAN FRANCISCO STFlagstaff, AZ 86001-1435
Mailing AddressPo Box 2456Flagstaff, AZ 86003-2456 · (928) 774-3400
Sole ProprietorNo
Enumeration DateMay 16, 2007
Last NPPES UpdateFebruary 13, 2009
NPI 1942417696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in AZ · 3096
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Also ListedMarriage & Family TherapistTaxonomy 106H00000X · License LMFT0324 (AZ)
1515 N SAN FRANCISCO ST, Flagstaff, AZ 86001

Other Names 1

Former Name (1)Dr. Michelle Dereschuk Ph.d.

Other Identifiers 1

Medicare ID-Type UnspecifiedPHD3096AZ · Medicare Identifier

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Michelle Dereschuk Gray Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2023 through October 1, 2027.

Opt-Out Effective DateOctober 1, 2023
Opt-Out In Effect ThroughOctober 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Marriage & Family Therapist
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychologist
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychologist
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychiatry & Neurology (Psychiatry)
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychiatry & Neurology (Psychiatry)
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychiatry & Neurology (Psychiatry)
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychiatry & Neurology (Psychiatry)
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001
Psychiatry & Neurology (Psychiatry)
1515 N SAN FRANCISCO ST
FLAGSTAFF, AZ 86001

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1942417696, enumerated as an "individual" on May 16, 2007.

The provider is located at 1515 N SAN FRANCISCO ST FLAGSTAFF, AZ 86001 and the phone number is (928) 774-3400.

Psychologist with taxonomy code 103T00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.