Healthcare Provider Details

I. General information

NPI: 1174897797
Provider Name (Legal Business Name): GRAY MATTERS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 RUE BEAUREGARD STE 100
LAFAYETTE LA
70508-3285
US

IV. Provider business mailing address

234 RUE BEAUREGARD STE 100
LAFAYETTE LA
70508-3285
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-0830
  • Fax: 337-593-0122
Mailing address:
  • Phone: 337-593-0830
  • Fax: 337-593-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2351
License Number StateLA

VIII. Authorized Official

Name: GAY CHALPIN
Title or Position: OWNER
Credential: L.C.S.W.
Phone: 337-593-0830