Organization Active NPI

Gray Matter Neuropsyhcological Consultants, LLC Dba the Mind Studio

  • Clinical Neuropsychologist
  • Niceville, FL
National Provider Identifier
1760119978
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
GRAY MATTER NEUROPSYHCOLOGICAL CONSULTANTS, LLC DBA THE MIND STUDIO
Doing business as
The Mind Studio
Practice address
1403 Cat Mar Rd
Niceville, FL 32578-9742
Phone
(850) 696-6640
Fax
(850) 696-6640
NPI assigned
Aug 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Ms. Ashley Luella Downey
Title
Practice Manager
Phone
(850) 696-6640

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

1403 Cat Mar Rd
Niceville, FL 32578-9742

Mailing address

1403 Cat Mar Rd
Niceville, FL 32578-9742
Phone (850) 816-0408

Other identifiers 3

IdentifierTypeStateIssuer
14779277176OtherNPI
1811436371OtherNPI
1750451019OtherNPI

Other names 1

  • The Mind Studio Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220928001153 FL Part B Supplier - Clinic/Group Practice 6901282979 Receives reassigned benefits from 3 practitioners
Practice locations: Niceville, FL

National Provider Directory

National Provider Directory

Locations

1403 Cat Mar Rd
Niceville, FL 32578
Phone (850) 696-6640

Practitioners & affiliated clinicians

Practitioners 5

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": "1659830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1760119978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 CAT MAR RD",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789742",
            "telephone_number": "850-816-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 CAT MAR RD",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789742",
            "telephone_number": "850-696-6640",
            "fax_number": "850-696-6640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAY MATTER NEUROPSYHCOLOGICAL CONSULTANTS, LLC DBA THE MIND STUDIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-07",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "DOWNEY",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "LUELLA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "850-696-6640",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "14779277176",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811436371",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1750451019",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Mind Studio",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Mind Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; 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.