Healthcare Provider Details

I. General information

NPI: 1821976622
Provider Name (Legal Business Name): MCKINZIE RAY M.S, LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PARK ST SE
ARDMORE OK
73401-8364
US

IV. Provider business mailing address

906 3RD AVE SW
ARDMORE OK
73401-4811
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-1838
  • Fax:
Mailing address:
  • Phone: 580-504-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: