Provider Demographics
NPI:1477766079
Name:BRAY, SOPHIA KARLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:KARLA
Last Name:BRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:KARLA
Other - Last Name:AADLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:285 WINDOVER RD
Mailing Address - Street 2:
Mailing Address - City:PIPERTON
Mailing Address - State:TN
Mailing Address - Zip Code:38017-5153
Mailing Address - Country:US
Mailing Address - Phone:901-414-2331
Mailing Address - Fax:
Practice Address - Street 1:285 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:PIPERTON
Practice Address - State:TN
Practice Address - Zip Code:38017-5153
Practice Address - Country:US
Practice Address - Phone:901-414-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2618103T00000X
AR89-3P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56166OtherBCBS OF ARKANSAS
AR56166OtherBCBS OF ARKANSAS