Healthcare Provider Details

I. General information

NPI: 1013344712
Provider Name (Legal Business Name): VICKY ANN RAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKY ANN KELLER LPC

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 WILLOW SPRINGS RD STE 100
HASLET TX
76052-3584
US

IV. Provider business mailing address

5751 PARK VISTA CIR STE 101
FORT WORTH TX
76244-5693
US

V. Phone/Fax

Practice location:
  • Phone: 817-812-2880
  • Fax: 817-812-3096
Mailing address:
  • Phone: 817-812-2880
  • Fax: 817-812-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: