Provider Demographics
NPI:1609688100
Name:GRAY MATTERS WORKSHOP, LLC
Entity type:Organization
Organization Name:GRAY MATTERS WORKSHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED-MFT, LMFT
Authorized Official - Phone:865-309-0714
Mailing Address - Street 1:238 W OLD AJ HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-1801
Mailing Address - Country:US
Mailing Address - Phone:865-469-2007
Mailing Address - Fax:
Practice Address - Street 1:238 W OLD AJ HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-1801
Practice Address - Country:US
Practice Address - Phone:865-469-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health