Provider Demographics
NPI:1518247519
Name:RAY, MARJORIE WILLIAMS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:WILLIAMS
Last Name:RAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:604 WEST FINALE AVENUE
Mailing Address - City:PORTER
Mailing Address - State:OK
Mailing Address - Zip Code:74454-0402
Mailing Address - Country:US
Mailing Address - Phone:918-441-6910
Mailing Address - Fax:918-483-0080
Practice Address - Street 1:604 W FINALE
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:OK
Practice Address - Zip Code:74454-1142
Practice Address - Country:US
Practice Address - Phone:918-441-6910
Practice Address - Fax:918-483-0080
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213062L101Y00000X
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor