Provider Demographics
NPI:1407488307
Name:RAY, BRANDY (MA, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27115 COURTNEY PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-5662
Mailing Address - Country:US
Mailing Address - Phone:636-362-6944
Mailing Address - Fax:
Practice Address - Street 1:2085 BLUESTONE DR STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6727
Practice Address - Country:US
Practice Address - Phone:636-362-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018027685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional