Healthcare Provider Details

I. General information

NPI: 1225649221
Provider Name (Legal Business Name): ABBY RAY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 GETWELL RD STE 212D
SOUTHAVEN MS
38672-7320
US

IV. Provider business mailing address

1473 BILOXI ST
HERNANDO MS
38632-1225
US

V. Phone/Fax

Practice location:
  • Phone: 662-228-0130
  • Fax: 678-868-2843
Mailing address:
  • Phone: 901-647-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number261018
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75397
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: