Healthcare Provider Details

I. General information

NPI: 1275448300
Provider Name (Legal Business Name): GRAY MATTER SPACES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LITCHFIELD RD
NEW MILFORD CT
06776-2002
US

IV. Provider business mailing address

PO BOX 83
SOUTHBURY CT
06488-0083
US

V. Phone/Fax

Practice location:
  • Phone: 475-370-7116
  • Fax:
Mailing address:
  • Phone: 475-370-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON MICHAEL GRAY
Title or Position: FOUNDER
Credential: LPC, LADC
Phone: 475-370-7116