Provider Demographics
NPI:1730407933
Name:RAY, SHAWN EDWARD (CMC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:EDWARD
Last Name:RAY
Suffix:
Gender:M
Credentials:CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 NE 10TH ST APT 256
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3610
Mailing Address - Country:US
Mailing Address - Phone:405-313-7599
Mailing Address - Fax:
Practice Address - Street 1:7835 NE 10TH ST APT 256
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3610
Practice Address - Country:US
Practice Address - Phone:405-313-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation