NPIMap

Organization Active NPI

David Gray P.C.

  • Mental Health Counselor
  • Libertyville, IL
National Provider Identifier
1306306378
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
DAVID GRAY P.C.
Doing business as
Gray Matter Therapy
Gray Therapeutics
Practice address
1580 S Milwaukee Ave
Libertyville, IL 60048-3764
Phone
(440) 714-8822
NPI assigned
Mar 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Authorized official

Name
David S Gray, LCPCNPI 1649636077
Title
President
Phone
(440) 714-8822

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: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1580 S Milwaukee Ave
Libertyville, IL 60048-3764

Mailing address

22072 W Engle Dr
Lake Villa, IL 60046-5411

Other identifiers 1

IdentifierTypeStateIssuer
1649636077OtherILNPI

Other names 2

  • Gray Matter Therapy Doing business as
  • Gray Therapeutics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1553472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560124800000",
    "number": "1306306378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22072 W ENGLE DR",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600465411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 S MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483764",
            "telephone_number": "440-714-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID GRAY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-25",
        "last_updated": "2019-06-10",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-714-8822",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649636077",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gray Matter Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gray Therapeutics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gray Therapeutics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; 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.