MEDICARE: MICHELLE DAWN RAY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	62096	TX

General Provider Information

NPI Number	:	1770853335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DAWN RAY LCSW

Provider Business Mailing Address
First Line	:	806 E AVENUE D STE F
Second Line	:
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-2231
Country	:	US
Telephone Number	:	254-547-6415
Fax Number	:	254-547-2030

Provider Business Practice Location Address
First Line	:	806 E AVENUE D STE F
Second Line	:
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-2231
Country	:	US
Telephone Number	:	254-547-6415
Fax Number	:	254-547-2030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	03/31/2016

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