Healthcare Provider Details

I. General information

NPI: 1427527423
Provider Name (Legal Business Name): GRAYSON LAWRENCE MOODY LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 24TH AVE S STE 260
SEATTLE WA
98144-4644
US

IV. Provider business mailing address

108 S JACKSON ST STE 301
SEATTLE WA
98104-2872
US

V. Phone/Fax

Practice location:
  • Phone: 206-382-5340
  • Fax:
Mailing address:
  • Phone: 360-441-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH6115499
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: