Provider Demographics
NPI:1902165541
Name:BRAY, CRYSTAL EUGENA (MS)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:EUGENA
Last Name:BRAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 NW 58TH ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7090
Mailing Address - Country:US
Mailing Address - Phone:405-361-8590
Mailing Address - Fax:405-456-1839
Practice Address - Street 1:6301 N MERIDIAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1267
Practice Address - Country:US
Practice Address - Phone:405-604-6801
Practice Address - Fax:405-604-8791
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor