Basic Information
| Provider Information | |||||||||
| NPI: | 1265942494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 LAMAR AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662023234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138264200 | ||||||||
| FaxNumber: | 9138261589 | ||||||||
| Practice Location | |||||||||
| Address1: | 6440 NIEMAN RD | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662033326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138264200 | ||||||||
| FaxNumber: | 9138261589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2017 | ||||||||
| LastUpdateDate: | 10/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 8167 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.