Irving O Grayson Jr. – Mental Health Counselor

Key facts

NPI: 1568089274
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
Practice address: 1555 N. Main St.
Fayette, MS 39069
Phone: (601) 786-8091
Fax: (601) 786-8023
NPI assigned: Jun 29, 2020
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X			Yes

Addresses

Primary practice location

1555 N. Main St.
Fayette, MS 39069

Mailing address

805 N Beech Street Suite 2
Tallulah, LA 71282
Phone (318) 493-5147

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 14, 2024.

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1568089274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N BEECH STREET SUITE 2",
            "city": "TALLULAH",
            "state": "LA",
            "postal_code": "71282",
            "telephone_number": "318-493-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 N. MAIN ST.",
            "city": "FAYETTE",
            "state": "MS",
            "postal_code": "39069",
            "telephone_number": "601-786-8091",
            "fax_number": "601-786-8023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYSON",
        "first_name": "IRVING",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-29",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayette, MS

All providers in Fayette, MS · Mental Health Counselor in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.