Provider Demographics
NPI:1932726619
Name:GRAYL, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:GRAYL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NIKLES DR STE 2H
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2588
Mailing Address - Country:US
Mailing Address - Phone:406-548-4675
Mailing Address - Fax:
Practice Address - Street 1:601 NIKLES DR STE 2H
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2588
Practice Address - Country:US
Practice Address - Phone:406-548-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-590401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical