Healthcare Provider Details

I. General information

NPI: 1992604672
Provider Name (Legal Business Name): MS. BETHANY LYNN WRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S LOWELL RD
JASPER AL
35503-6105
US

IV. Provider business mailing address

32157 HIGHWAY 69
JASPER AL
35504-5131
US

V. Phone/Fax

Practice location:
  • Phone: 205-522-7614
  • Fax:
Mailing address:
  • Phone: 205-522-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: