Provider Demographics
NPI:1073262382
Name:WRAY, ANNA MARIE (LMLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:WRAY
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E DOUGLAS AVE APT 819
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3428
Mailing Address - Country:US
Mailing Address - Phone:316-922-0000
Mailing Address - Fax:
Practice Address - Street 1:7829 E ROCKHILL ST STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3919
Practice Address - Country:US
Practice Address - Phone:316-686-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist