Provider Demographics
NPI:1407696248
Name:GRAY MATTER COUNSELING LLC
Entity type:Organization
Organization Name:GRAY MATTER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-907-4675
Mailing Address - Street 1:1900 CRESTWOOD BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2056
Mailing Address - Country:US
Mailing Address - Phone:205-907-4675
Mailing Address - Fax:
Practice Address - Street 1:1900 CRESTWOOD BLVD STE 303
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2056
Practice Address - Country:US
Practice Address - Phone:205-907-4675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty