Provider Demographics
NPI:1144377078
Name:GREY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:GREY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ART THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-BC, CPAT
Authorized Official - Phone:270-384-1736
Mailing Address - Street 1:933 RUSSELL RD
Mailing Address - Street 2:SUITE 93
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1054
Mailing Address - Country:US
Mailing Address - Phone:280-384-1736
Mailing Address - Fax:270-384-1734
Practice Address - Street 1:933 RUSSELL RD
Practice Address - Street 2:SUITE 93
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1054
Practice Address - Country:US
Practice Address - Phone:280-384-1736
Practice Address - Fax:270-384-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-CPAT-0052251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY29101037Medicaid