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General NPI Number Information
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NPI Number | 1114144482
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Entity Type | Organization
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Legal Business Name | ANDRA RAY
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4728 NETA LN HOPE CENTER FOR CHRISTIAN COUNSELING
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City | WICHITA FALLS
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State | TX
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Zip | 76302-3416
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Country | US
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Telephone | 940-767-4673
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Fax | 940-549-2886
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Provider Business Mailing Address
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Address Line | 617 3RD ST
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City | GRAHAM
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State | TX
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Zip | 76450-3101
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Country | US
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Telephone | 940-549-2259
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Fax | 940-549-2886
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Authorized Official
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Title or Position | OWNER
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Name | ANDRA RAY
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Credential | LPC
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Telephone | 940-549-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14450
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13713
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License Number State | TX
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