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NPI Code Detail

MEDICARE: BRANDILYN RAY

MEDICARE: BRANDILYN RAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YP2500XProfessional Counselor1469KY

General Provider Information

NPI Number : 1295992113
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDILYN RAY
Provider Business Mailing Address
First Line : 938 MULBERRY ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40217-1251
Country : US
Telephone Number : 502-314-1317
Fax Number :
Provider Business Practice Location Address
First Line : 1100 E MARKET ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-1838
Country : US
Telephone Number : 502-596-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2008
Last Update Date : 10/03/2014

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Directions to “ BRANDILYN RAY ” Practice Location

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