Provider Demographics
NPI:1720388200
Name:MCCRAY, KENYA R (LISAC)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:R
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:LISAC
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 3160
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85117-4115
Mailing Address - Country:US
Mailing Address - Phone:928-344-9490
Mailing Address - Fax:480-288-5339
Practice Address - Street 1:290 S 1ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2260
Practice Address - Country:US
Practice Address - Phone:928-344-9490
Practice Address - Fax:480-288-5339
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10480101YA0400X
AZ10480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)