Provider Demographics
NPI:1447356423
Name:RAY, WENDEL ALFRED (PHD)
Entity type:Individual
Prefix:DR
First Name:WENDEL
Middle Name:ALFRED
Last Name:RAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 BAYOU SHORES DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4231
Mailing Address - Country:US
Mailing Address - Phone:318-547-4539
Mailing Address - Fax:
Practice Address - Street 1:108 FILHIOL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3828
Practice Address - Country:US
Practice Address - Phone:318-791-8948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1558101YP2500X
27321041C0700X
LA32106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist