Provider Demographics
NPI:1245900109
Name:RAY, MONIQUE J (BS, RBT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:J
Last Name:RAY
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 JUDY LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2537
Mailing Address - Country:US
Mailing Address - Phone:901-672-4347
Mailing Address - Fax:
Practice Address - Street 1:4111 S MSU B ST BLDG 48
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-4180
Practice Address - Country:US
Practice Address - Phone:901-584-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician