Provider Demographics
NPI:1366011207
Name:RAY, TERRYE-DANIELLE ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:TERRYE-DANIELLE
Middle Name:ELIZABETH
Last Name:RAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-7022
Mailing Address - Country:US
Mailing Address - Phone:662-210-3279
Mailing Address - Fax:
Practice Address - Street 1:1114 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9301
Practice Address - Country:US
Practice Address - Phone:662-840-6366
Practice Address - Fax:662-680-9797
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9253104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker