Provider Demographics
NPI:1972840767
Name:BRAY, NATHAN PAUL (LPC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:BRAY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7378 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-4803
Mailing Address - Country:US
Mailing Address - Phone:337-436-7553
Mailing Address - Fax:
Practice Address - Street 1:4400 TAMARACK ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4427
Practice Address - Country:US
Practice Address - Phone:337-515-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health