MEDICARE: CELESTINE GRAYSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		IN

General Provider Information

NPI Number	:	1639963754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTINE GRAYSON NP

Provider Business Mailing Address
First Line	:	185 HOSPITAL LN
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4247
Country	:	US
Telephone Number	:	812-243-9954
Fax Number	:	812-605-5013

Provider Business Practice Location Address
First Line	:	185 HOSPITAL LN
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4247
Country	:	US
Telephone Number	:	812-243-9954
Fax Number	:	812-605-5013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	02/06/2026

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