MEDICARE: ALLISON COVILLE BRAY PHD

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	103TC0700X	Clinical Psychologist	103137	NC

General Provider Information

NPI Number	:	1821469123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON COVILLE BRAY PHD

Provider Business Mailing Address
First Line	:	606 WALTER REED DR
Second Line	:	SUITE B
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1114
Country	:	US
Telephone Number	:	336-547-1574
Fax Number	:	336-323-5247

Provider Business Practice Location Address
First Line	:	606 WALTER REED DR
Second Line	:	SUITE B
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1114
Country	:	US
Telephone Number	:	336-547-1574
Fax Number	:	336-323-5247

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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