Provider Demographics
NPI:1043042641
Name:RAY, MAISIE GRACE (LMFT)
Entity type:Individual
Prefix:
First Name:MAISIE
Middle Name:GRACE
Last Name:RAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 CAMP BOWIE BLVD STE 298
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5508
Mailing Address - Country:US
Mailing Address - Phone:817-968-1905
Mailing Address - Fax:817-612-3371
Practice Address - Street 1:6115 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5512
Practice Address - Country:US
Practice Address - Phone:817-968-1905
Practice Address - Fax:817-612-3371
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist