Provider Demographics
NPI:1528451804
Name:BRAY, ANNA JUNE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:JUNE
Last Name:BRAY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3503
Mailing Address - Country:US
Mailing Address - Phone:573-426-4455
Mailing Address - Fax:
Practice Address - Street 1:1450 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3648
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2024-04-05
Deactivation Date:2015-12-21
Deactivation Code:
Reactivation Date:2019-12-27
Provider Licenses
StateLicense IDTaxonomies
MO2014027778101YP2500X
MO4854101YA0400X
MO5868101YA0400X
MO1001101YA0400X
MO751328101YA0400X
MO128814101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)