Provider Demographics
NPI:1154512473
Name:BRAY, GARY STEVEN (M S,, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEVEN
Last Name:BRAY
Suffix:
Gender:M
Credentials:M S,, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOSPITAL DR.
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:850-833-7400
Mailing Address - Fax:850-833-7528
Practice Address - Street 1:BLACKWATER STOP CAMP
Practice Address - Street 2:2451 STOP CAMP ROAD
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-9111
Practice Address - Country:US
Practice Address - Phone:850-957-0995
Practice Address - Fax:850-957-1000
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765922900Medicaid