Provider Demographics
NPI:1861521619
Name:BRAY, ALLEN (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:
Last Name:BRAY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21310 HIGHWAY 51 MALVERN, AR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104
Mailing Address - Country:US
Mailing Address - Phone:501-337-9090
Mailing Address - Fax:
Practice Address - Street 1:21310 HIGHWAY 51
Practice Address - Street 2:21310 HIGHWAY 51
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-8693
Practice Address - Country:US
Practice Address - Phone:501-337-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0709053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional