Individual
BONNIE BRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
99 EAST FORK ROAD, HAILEY, ID 83333
(208) 788-4994
Mailing address
PO BOX 2906, KETCHUM, ID 83340-2900
(208) 788-4994
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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