# GRAY WOLF COUNSELING, INC.

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

## Provider details

- **NPI number:** 1700233699
- **Authorized official:** MR. ROBERT HOWARD MEDDAUGH MS,MFT,LADC, CPGC (OWNER - THERAPIST)
- **Authorized official phone:** (505) 506-1877

## Contact information

- **Practice address:** 854 MISSION VALLEY RD, CORRALES, NM 87048-7829
- **Practice address phone:** (505) 506-1877
- **Mailing address:** 854 MISSION VALLEY RD, CORRALES, NM 87048-7829
- **Mailing address phone:** (505) 506-1877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | 0125 | NV | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 0162551 | NM | — |
| 106H00000X | Marriage & Family Therapist | 0145071 | NM | Yes |

## Other

- **Enumeration date:** 05/20/2016
- **Last updated:** 05/20/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 033514011 | NM CRS | NM |