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General NPI Number Information
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NPI Number | 1720894710
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Entity Type | Organization
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Legal Business Name | GRAY MATTERS THERAPY LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 102 WALNUT ST STE 303
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City | WINONA
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State | MN
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Zip | 55987-5641
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Country | US
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Telephone | 515-710-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 100 LATSCH SQ STE 203
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City | WINONA
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State | MN
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Zip | 55987-2995
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Country | US
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Telephone | 515-710-4002
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MICHAEL DONNENWERTH
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Credential | DPM
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Telephone | 507-450-7091
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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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