Provider Demographics
NPI:1952647406
Name:RAY, BILLY VAN (MED)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:VAN
Last Name:RAY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 BERKLEY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4153
Mailing Address - Country:US
Mailing Address - Phone:405-330-2417
Mailing Address - Fax:
Practice Address - Street 1:2925 BERKLEY DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4153
Practice Address - Country:US
Practice Address - Phone:405-330-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling