Provider Demographics
NPI:1174864789
Name:WRAY, MELANIE (BCBA & DIAGNOSTICIAN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:BCBA & DIAGNOSTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:CALL
Mailing Address - State:TX
Mailing Address - Zip Code:75933-0193
Mailing Address - Country:US
Mailing Address - Phone:409-622-9796
Mailing Address - Fax:409-420-0678
Practice Address - Street 1:280 COUNTY ROAD 4111
Practice Address - Street 2:
Practice Address - City:CALL
Practice Address - State:TX
Practice Address - Zip Code:75933-4618
Practice Address - Country:US
Practice Address - Phone:409-622-9796
Practice Address - Fax:409-420-0678
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11312866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst