Provider Demographics
NPI:1316681067
Name:RAY, KEELEY
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEELEY
Other - Middle Name:
Other - Last Name:CALLAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-ASSOCIATE
Mailing Address - Street 1:240 LOVERS PATH DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-3045
Mailing Address - Country:US
Mailing Address - Phone:817-907-2728
Mailing Address - Fax:
Practice Address - Street 1:240 LOVERS PATH DR
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-3045
Practice Address - Country:US
Practice Address - Phone:817-382-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87698101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor