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General NPI Number Information
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NPI Number | 1396821294
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Entity Type | Individual
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Provider Name | DIANA LYNN BRAY M.S.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3202 MCINTOSH CIRCLE STE. LL02
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City | JOPLIN
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State | MO
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Zip | 64801-3646
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Country | US
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Telephone | 417-347-3508
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Fax | 417-347-3503
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Provider Business Mailing Address
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Address Line | 3410 TEN PIN LANE
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City | JOPLIN
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State | MO
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Zip | 64801-8273
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Country | US
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Telephone | 417-782-5865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | NBCC CERT. 48566
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License Number State | MO
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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 | 2000158120
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License Number State | MO
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