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General NPI Number Information
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NPI Number | 1275448300
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Entity Type | Organization
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Legal Business Name | GRAY MATTER SPACES LLC
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 61 RUSS ST
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City | HARTFORD
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State | CT
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Zip | 06106-1523
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Country | US
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Telephone | 475-370-7116
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83
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City | SOUTHBURY
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State | CT
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Zip | 06488-0083
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Country | US
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Telephone | 475-370-7116
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. JASON MICHAEL GRAY
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Credential | LPC, LADC
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Telephone | 475-370-7116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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