Provider Demographics
NPI:1760119978
Name:GRAY MATTER NEUROPSYHCOLOGICAL CONSULTANTS, LLC DBA THE MIND STUDIO
Entity Type:Organization
Organization Name:GRAY MATTER NEUROPSYHCOLOGICAL CONSULTANTS, LLC DBA THE MIND STUDIO
Other - Org Name:THE MIND STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:LUELLA
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-696-6640
Mailing Address - Street 1:1403 CAT MAR RD
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9742
Mailing Address - Country:US
Mailing Address - Phone:850-816-0408
Mailing Address - Fax:
Practice Address - Street 1:1403 CAT MAR RD
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9742
Practice Address - Country:US
Practice Address - Phone:850-816-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811436371OtherNPI
1750451019OtherNPI
14779277176OtherNPI