Provider Demographics
NPI:1609527456
Name:MCCRAY, MALISHA (BCBA)
Entity Type:Individual
Prefix:
First Name:MALISHA
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:BCBA
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 2192
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-2192
Mailing Address - Country:US
Mailing Address - Phone:870-208-8362
Mailing Address - Fax:870-208-8384
Practice Address - Street 1:205 INGRAM BLVD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3423
Practice Address - Country:US
Practice Address - Phone:870-739-6818
Practice Address - Fax:870-551-3724
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-21-56637103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst