Provider Demographics
NPI:1699029868
Name:GRAY-MARTIN, RITA ELAINE (M ED)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:ELAINE
Last Name:GRAY-MARTIN
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 1:13702 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9780
Mailing Address - Country:US
Mailing Address - Phone:405-843-0334
Mailing Address - Fax:
Practice Address - Street 1:13702 OXFORD DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9780
Practice Address - Country:US
Practice Address - Phone:405-843-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional