Gray Matter Partners

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

LP4963 Issued in MN

Legal business name

GRAY MATTER PARTNERS

Practice address

16809 260TH Ave
MC Grath, MN 56350-4538

Phone

(612) 716-3925

NPI assigned

Feb 18, 2012

Last updated

Feb 18, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Theodore Orth, LICENSED PSYCHOLOGISNPI 1811149651

Title

Clinical Director

Phone

(612) 716-3925

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Theodore Orth, LP

  • Clinical Psychologist
  • McGrath, MN
  • NPI 1811149651
  NPD (past) Authorized official

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

{
    "created_epoch": "1329523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329523200000",
    "number": "1083987291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16809 260TH AVE",
            "city": "MC GRATH",
            "state": "MN",
            "postal_code": "563504538",
            "telephone_number": "612-716-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16809 260TH AVE",
            "city": "MC GRATH",
            "state": "MN",
            "postal_code": "563504538",
            "telephone_number": "612-716-3925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAY MATTER PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-18",
        "last_updated": "2012-02-18",
        "status": "A",
        "authorized_official_last_name": "ORTH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "612-716-3925",
        "authorized_official_credential": "LICENSED PSYCHOLOGIS"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "LP4963",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "LP4963",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Theodore Orth, LP

• Adult Mental Health Clinic/Center in McGrath, MN
• Providers in McGrath, MN by specialty
• Adult Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.