Provider Demographics
NPI:1013291525
Name:WRAY, KELLY S (LADC CANDIDATE)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:S
Last Name:WRAY
Suffix:
Gender:M
Credentials:LADC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 W PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1711
Mailing Address - Country:US
Mailing Address - Phone:580-370-5617
Mailing Address - Fax:
Practice Address - Street 1:804 W CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2310
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)