Provider Demographics
NPI:1194549089
Name:GRAY MATTER SOLUTIONS LLC
Entity type:Organization
Organization Name:GRAY MATTER SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAUP
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, APNP, BC
Authorized Official - Phone:262-206-0412
Mailing Address - Street 1:3224 KENNSINGTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-2821
Mailing Address - Country:US
Mailing Address - Phone:262-206-0412
Mailing Address - Fax:
Practice Address - Street 1:3224 KENNSINGTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-2821
Practice Address - Country:US
Practice Address - Phone:262-206-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)