Healthcare Provider Details

I. General information

NPI: 1477981561
Provider Name (Legal Business Name): ANNTRICIA MARIE BRAY M. ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E JACKSON ST
HUGO OK
74743-4036
US

IV. Provider business mailing address

109 E MAIN ST 203 E. JACKSON
HUGO OK
74743-6237
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-9289
  • Fax:
Mailing address:
  • Phone: 580-317-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: