1932747979 NPI number — MS. WENONA NEPHTA-LI WRAY LPC, NCC

Table of content: MS. WENONA NEPHTA-LI WRAY LPC, NCC (NPI 1932747979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932747979 NPI number — MS. WENONA NEPHTA-LI WRAY LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRAY
Provider First Name:
WENONA
Provider Middle Name:
NEPHTA-LI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932747979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATALIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78059-0251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-434-1933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
977 COUNTY ROAD 6711 STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATALIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78059-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-772-6009
Provider Business Practice Location Address Fax Number:
830-772-6019
Provider Enumeration Date:
12/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  79763 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 448289501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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