Individual
MR. LARRY G RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
115 N. CLEVELAND AVENUE, BROOKHAVEN, MS 39601-2713
(601) 835-3306
(601) 835-3342
Mailing address
115 N. CLEVELAND AVENUE, BROOKHAVEN, MS 39601-2713
(601) 835-3306
(601) 835-3342
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C1141
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123920
—
MS
05
—
05923703
—
MS
Enumeration date
09/24/2008
Last updated
12/20/2019
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