Provider Demographics
NPI:1386114809
Name:GRAYDON, MARY READING (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:READING
Last Name:GRAYDON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 S MCDONOUGH ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104
Mailing Address - Country:US
Mailing Address - Phone:334-523-6650
Mailing Address - Fax:
Practice Address - Street 1:313 S MCDONOUGH ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104
Practice Address - Country:US
Practice Address - Phone:334-523-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568986925Other2-ORG