Healthcare Provider Details

I. General information

NPI: 1336340884
Provider Name (Legal Business Name): PRISCILLA RAY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6624 FANNIN ST SUITE 2120
HOUSTON TX
77030-2312
US

IV. Provider business mailing address

6624 FANNIN ST SUITE 2120
HOUSTON TX
77030-2312
US

V. Phone/Fax

Practice location:
  • Phone: 713-797-0112
  • Fax: 713-790-9578
Mailing address:
  • Phone: 713-797-0112
  • Fax: 713-790-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberE2808
License Number StateTX

VIII. Authorized Official

Name: DR. PRISCILLA RAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 713-797-0112