MEDICARE: GREY MATTER CONCEPTS,INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	261QH0100X	Health Service Clinic/Center
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649881020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREY MATTER CONCEPTS,INC.

Provider Business Mailing Address
First Line	:	5514 MUSIC ST.
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122
Country	:	US
Telephone Number	:	504-357-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	5514 MUSIC ST.
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122
Country	:	US
Telephone Number	:	504-357-0092
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ANICE BUTLER
Credential	:	LCSW
Telephone Number	:	504-357-0092

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/11/2020

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