Provider Demographics
NPI:1770853335
Name:RAY, MICHELLE DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:806 E AVENUE D STE F
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2231
Mailing Address - Country:US
Mailing Address - Phone:254-547-6415
Mailing Address - Fax:254-547-2030
Practice Address - Street 1:806 E AVENUE D STE F
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2231
Practice Address - Country:US
Practice Address - Phone:254-547-6415
Practice Address - Fax:254-547-2030
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical