Provider Demographics
NPI:1689668345
Name:BRAY, STACY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANN
Last Name:BRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2702 CUNNINGHAM AVE
Mailing Address - Street 2:STE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1570
Mailing Address - Country:US
Mailing Address - Phone:417-782-1910
Mailing Address - Fax:417-782-1844
Practice Address - Street 1:2702 CUNNINGHAM AVE
Practice Address - Street 2:STE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1570
Practice Address - Country:US
Practice Address - Phone:417-782-1910
Practice Address - Fax:417-782-1844
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005004515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200972540AMedicaid
MO1689668345Medicaid
MO1366779100OtherGREATER OZARKS RURAL PSYCHOLOGISTS
KS200972540AMedicaid