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General NPI Number Information
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NPI Number | 1093256604
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Entity Type | Organization
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Legal Business Name | GREYLEY WELLNESS LLC
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 2010 EASTWOOD DR STE 300
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City | MADISON
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State | WI
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Zip | 53704-5387
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Country | US
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Telephone | 608-509-9287
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Fax | 608-630-8089
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Provider Business Mailing Address
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Address Line | 2010 EASTWOOD DR STE 300
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City | MADISON
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State | WI
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Zip | 53704-5387
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Country | US
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Telephone | 608-509-9287
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Fax | 608-630-8089
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE E MOLL
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Credential | LCSW
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Telephone | 608-419-6103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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