Provider Demographics
NPI:1760952683
Name:GRAYSON, NICOLE CATHERINE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:CATHERINE
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 W LEOTA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7111
Mailing Address - Country:US
Mailing Address - Phone:530-736-0872
Mailing Address - Fax:
Practice Address - Street 1:1137 W LEOTA RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7111
Practice Address - Country:US
Practice Address - Phone:530-736-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMF101668106H00000X
IN35002154A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist