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General NPI Number Information
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NPI Number | 1861521619
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Entity Type | Individual
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Provider Name | ALLEN BRAY M.S., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 21310 HIGHWAY 51 21310 HIGHWAY 51
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City | MALVERN
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State | AR
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Zip | 72104-8693
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Country | US
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Telephone | 501-337-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 21310 HIGHWAY 51 MALVERN, AR
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City | MALVERN
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State | AR
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Zip | 72104
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Country | US
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Telephone | 501-337-9090
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0709053
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License Number State | AR
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