MEDICARE: GRAY MATTERS THERAPY LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1720894710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAY MATTERS THERAPY LLC

Provider Business Mailing Address
First Line	:	100 LATSCH SQ STE 203
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-2995
Country	:	US
Telephone Number	:	515-710-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 WALNUT ST STE 303
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-5641
Country	:	US
Telephone Number	:	515-710-4002
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MICHAEL DONNENWERTH
Credential	:	DPM
Telephone Number	:	507-450-7091

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	01/28/2026

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Directions to “GRAY MATTERS THERAPY LLC ” Practice Location

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