# GRAY HORSE MENTAL WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508330101
- **Authorized official:** MANDY AYCOCK LPC (OWNER, PRACTITIONER)
- **Authorized official phone:** (913) 638-1246

## Contact information

- **Practice address:** 3500 N 99TH ST, KANSAS CITY, KS 66109
- **Practice address phone:** (913) 638-1246
- **Mailing address:** 4917 WOODSTOCK ST, SHAWNEE, KS 66218-9141
- **Mailing address phone:** (913) 638-1246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2019
- **Last updated:** 01/16/2019