Provider Demographics
NPI:1043052160
Name:BRAY, CRAIG (MFT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:BRAY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16195 LAGUNA ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-0600
Mailing Address - Country:US
Mailing Address - Phone:909-222-0594
Mailing Address - Fax:
Practice Address - Street 1:16195 LAGUNA ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-0600
Practice Address - Country:US
Practice Address - Phone:909-222-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist