Individual
CHARLES MCCRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8225 W TUCKEY LN, GLENDALE, AZ 85303-3210
(623) 463-1936
Mailing address
8225 W TUCKEY LN, GLENDALE, AZ 85303-3210
(623) 463-1936
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
9094
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
905903
AHCCCS ID
AZ
Enumeration date
11/29/2006
Last updated
07/08/2007
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