Provider Demographics
NPI:1124001904
Name:PRAY, ROGER THOMAS (PHD, EDD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:THOMAS
Last Name:PRAY
Suffix:
Gender:M
Credentials:PHD, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 PROPPS ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1554
Mailing Address - Country:US
Mailing Address - Phone:505-379-1778
Mailing Address - Fax:
Practice Address - Street 1:10200 PROPPS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1554
Practice Address - Country:US
Practice Address - Phone:505-379-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1102103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling