Provider Demographics
NPI:1851762116
Name:WRAY, BRENDA (LADC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 GRAINGER PKWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5083
Mailing Address - Country:US
Mailing Address - Phone:402-327-6822
Mailing Address - Fax:402-483-4594
Practice Address - Street 1:4600 VALLEY RD STE 223
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4892
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:402-483-4594
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)