Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MH14594 | FL |
Y | 103K00000X | Behavior Analyst | 1-16-23681 | FL |
NPI | 1003358185 |
---|---|
Provider Name | Melody Ray |
First Address | Fort Walton Beach, FL 32548-5772 |
Second Address | Fort Walton Beach, FL 32548-5772 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2016 |
Last Update Date | 07/11/2016 |