Provider Demographics
NPI:1477981561
Name:BRAY, ANNTRICIA MARIE (M ED)
Entity Type:Individual
Prefix:
First Name:ANNTRICIA
Middle Name:MARIE
Last Name:BRAY
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E MAIN ST
Mailing Address - Street 2:203 E. JACKSON
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-6237
Mailing Address - Country:US
Mailing Address - Phone:580-317-6841
Mailing Address - Fax:
Practice Address - Street 1:203 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4036
Practice Address - Country:US
Practice Address - Phone:580-326-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool