NPIMap

Organization Active NPI

Greyley Wellness LLC

  • Mental Health Counselor
  • Madison, WI
National Provider Identifier
1093256604
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
GREYLEY WELLNESS LLC
Practice address
2010 Eastwood Dr Ste 300
Madison, WI 53704-5387
Phone
(608) 509-9287
Fax
(608) 630-8089
NPI assigned
Mar 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Nicole E Moll, LCSWNPI 1578239851
Title
Owner
Phone
(608) 419-6103

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2010 Eastwood Dr Ste 300
Madison, WI 53704-5387

Mailing address

2010 Eastwood Dr Ste 300
Madison, WI 53704-5387
Phone (608) 509-9287

Other identifiers 1

IdentifierTypeStateIssuer
100176083MedicaidWI

Other names 1

  • Madison Trauma Therapy LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200504002365 WI Part B Supplier - Clinic/Group Practice 2860823036 Receives reassigned benefits from 10 practitioners
Practice locations: Madison, WI

National Provider Directory

National Provider Directory

Locations

4785 Hayes Rd
Ste 201
Madison, WI 53704
Phone (608) 509-9287

2010 Eastwood Dr
Ste 300
Madison, WI 53704
Phone (608) 509-9287

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1093256604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 EASTWOOD DR STE 300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537045387",
            "telephone_number": "608-509-9287",
            "fax_number": "608-630-8089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 EASTWOOD DR STE 300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537045387",
            "telephone_number": "608-509-9287",
            "fax_number": "608-630-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREYLEY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-15",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "MOLL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-419-6103",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100176083",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Trauma Therapy LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Madison Trauma Therapy LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.