Provider Demographics
NPI:1730457383
Name:RAY, JODI
Entity Type:Individual
Prefix:MISS
First Name:JODI
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45812 LOVINGS CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:HEAVENER
Mailing Address - State:OK
Mailing Address - Zip Code:74937-9110
Mailing Address - Country:US
Mailing Address - Phone:918-658-5644
Mailing Address - Fax:
Practice Address - Street 1:45812 LOVINGS CHURCH LN
Practice Address - Street 2:
Practice Address - City:HEAVENER
Practice Address - State:OK
Practice Address - Zip Code:74937-9110
Practice Address - Country:US
Practice Address - Phone:918-658-5644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-11
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health