Healthcare Provider Details

I. General information

NPI: 1609688100
Provider Name (Legal Business Name): GRAY MATTERS WORKSHOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 W OLD AJ HWY
JEFFERSON CITY TN
37760-1801
US

IV. Provider business mailing address

238 W OLD AJ HWY
JEFFERSON CITY TN
37760-1801
US

V. Phone/Fax

Practice location:
  • Phone: 865-469-2007
  • Fax:
Mailing address:
  • Phone: 865-469-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CANDICE ELAINE DURMAN
Title or Position: OWNER-PROVIDER
Credential: M.ED-MFT, LMFT
Phone: 865-309-0714