Provider Demographics
NPI:1780359570
Name:RAY, HEATHER JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:RAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SERENADE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6324
Mailing Address - Country:US
Mailing Address - Phone:405-473-7590
Mailing Address - Fax:
Practice Address - Street 1:203 HAL MULDROW DR STE 4A
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5288
Practice Address - Country:US
Practice Address - Phone:405-473-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8174-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker