Provider Demographics
NPI:1255203592
Name:GRAY OWL PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:GRAY OWL PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIEDZIC
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-595-2735
Mailing Address - Street 1:360 TRATEBAS RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9752
Mailing Address - Country:US
Mailing Address - Phone:224-595-2735
Mailing Address - Fax:
Practice Address - Street 1:6650 N NORTHWEST HWY STE 209
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1363
Practice Address - Country:US
Practice Address - Phone:773-470-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty