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General NPI Number Information
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NPI Number | 1285825356
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Entity Type | Organization
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Legal Business Name | SALLY RAY INC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 5009 N PENN AVE STE 116
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-8888
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Country | US
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Telephone | 405-636-9855
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Fax | 405-879-2388
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Provider Business Mailing Address
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Address Line | 5009 N PENN AVE STE 116
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-8888
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Country | US
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Telephone | 405-636-9855
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Fax | 405-879-2388
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Authorized Official
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Title or Position | LICENSED CLINICAL SOC. WORKER/OWNER
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Name | SALLY R RAY
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Credential | LCSW
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Telephone | 405-636-9855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1529
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License Number State | OK
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