Provider Demographics
NPI:1285825356
Name:SALLY RAY INC
Entity Type:Organization
Organization Name:SALLY RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOC. WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-636-9855
Mailing Address - Street 1:5009 N PENN AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8888
Mailing Address - Country:US
Mailing Address - Phone:405-636-9855
Mailing Address - Fax:405-879-2388
Practice Address - Street 1:5009 N PENN AVE STE 116
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8888
Practice Address - Country:US
Practice Address - Phone:405-636-9855
Practice Address - Fax:405-879-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK585566455002OtherBLUECROSS BLUESHIELD