Provider Demographics
NPI:1710598040
Name:BRAY, PAYTON (SLP)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25780 COUNTY ROAD 2450
Mailing Address - Street 2:
Mailing Address - City:KEMP
Mailing Address - State:TX
Mailing Address - Zip Code:75143-6826
Mailing Address - Country:US
Mailing Address - Phone:903-340-2011
Mailing Address - Fax:
Practice Address - Street 1:7801 N RICHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6415
Practice Address - Country:US
Practice Address - Phone:694-609-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist