Provider Demographics
NPI:1972376846
Name:GRACIOUS BAY COUNSELING PLLC
Entity Type:Organization
Organization Name:GRACIOUS BAY COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:781-630-1177
Mailing Address - Street 1:2 CLINTON TER
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1330
Mailing Address - Country:US
Mailing Address - Phone:781-630-1177
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA RD STE 11
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1842
Practice Address - Country:US
Practice Address - Phone:781-630-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty