Provider Demographics
NPI:1730438466
Name:GRAYSON, MARCI (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:BRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12125 E 65TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-4653
Mailing Address - Country:US
Mailing Address - Phone:317-721-5897
Mailing Address - Fax:
Practice Address - Street 1:715 E JOHNSON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-5315
Practice Address - Country:US
Practice Address - Phone:317-721-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002434A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health