Provider Demographics
NPI:1215210851
Name:RAY, GYPSY S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GYPSY
Middle Name:S
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-9093
Mailing Address - Country:US
Mailing Address - Phone:406-880-0977
Mailing Address - Fax:
Practice Address - Street 1:118 E 7TH ST STE 2D
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2913
Practice Address - Country:US
Practice Address - Phone:406-880-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1013-LCSW1041C0700X
MTBBH-LCSW-LIC-10131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0517990Medicaid