Provider Demographics
NPI:1801024286
Name:WRAY, PRUDENCE JAYNE (LMHC)
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:JAYNE
Last Name:WRAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 W CARMEL DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5877
Mailing Address - Country:US
Mailing Address - Phone:317-569-5433
Mailing Address - Fax:317-569-1767
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:SUITE 212
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-569-5433
Practice Address - Fax:317-569-1767
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000379A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health