NPIMap

Organization Active NPI

Graceway Counseling Services LLC

  • Family Nurse Practitioner
  • Huntington, WV
National Provider Identifier
1003405978
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
GRACEWAY COUNSELING SERVICES LLC
Practice address
744 4TH Ave Ste 2
Huntington, WV 25701-1541
Phone
(304) 691-0873
Fax
(304) 955-9057
NPI assigned
Jan 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew Maynard, MA, NCCNPI 1750970711
Title
Owner
Phone
(304) 691-0873

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Community/Behavioral Health Agency 251S00000X
Primary Care Clinic/Center 261QP2300X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

744 4TH Ave Ste 2
Huntington, WV 25701-1541

Mailing address

744 4TH Ave Ste 2
Huntington, WV 25701-1541
Phone (304) 691-0873

Other practice location 1

33 Walnut Ln
Huntington, WV 25704-9485
Phone (304) 638-1551

Other names 1

  • Graceway Counseling Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230811002420 WV Part B Supplier - Clinic/Group Practice 2264894963 Receives reassigned benefits from 7 practitioners
Practice locations: Huntington, WV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2290531Graceway Counseling Center744 4TH Avenue, Suite 2, Huntington, WV 25701Certificate of waiverSep 26, 2027

National Provider Directory

National Provider Directory

Locations

744 4th Ave
Ste 200
Huntington, WV 25701
Phone (304) 691-0873

744 4th Ave
Ste 2
Huntington, WV 25701
Phone (304) 691-0873

744 4th Ave
Huntington, WV 25701

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1003405978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 4TH AVE STE 2",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257011541",
            "telephone_number": "304-691-0873",
            "fax_number": "304-955-9057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 4TH AVE STE 2",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257011541",
            "telephone_number": "304-691-0873",
            "fax_number": "304-955-9057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33 Walnut Ln",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "WV",
            "postal_code": "257049485",
            "country_code": "US",
            "telephone_number": "304-638-1551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACEWAY COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-14",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-691-0873",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceway Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Graceway Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.