Provider Demographics
NPI:1699245613
Name:GRAY MATTERS COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:GRAY MATTERS COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LMHC
Authorized Official - Phone:603-387-4896
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1600
Mailing Address - Country:US
Mailing Address - Phone:603-387-4896
Mailing Address - Fax:
Practice Address - Street 1:501 UNION AVE
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2867
Practice Address - Country:US
Practice Address - Phone:603-260-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417495391OtherNPI TYPE 1