Provider Demographics
NPI:1790725323
Name:RAY, ANDRA LEIGH (ARNP, PMHNP-BC, LPC)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:LEIGH
Last Name:RAY
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3101
Mailing Address - Country:US
Mailing Address - Phone:940-549-2259
Mailing Address - Fax:940-549-2886
Practice Address - Street 1:617 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3101
Practice Address - Country:US
Practice Address - Phone:940-549-2259
Practice Address - Fax:940-549-2886
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140635363LP0808X
TX13713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027311203Medicaid