=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356231211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. TARA GRAY COUNSELING & WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 835 E 2ND AVE # 314B
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-769-9472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 ENGINE CREEK CT
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-8593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-769-9472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TARA MICHELLE GRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-769-9472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------