| Doctor Name: | MR. KELLY S. WRAY |
| NPI Number: | 1013291525 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC CANDIDATE |
| License Number: | |
| Business Practice Address: | 2530 S Commerce St Ardmore, OK - 734015519 |
| Business Phone Number: | 5802235636 |
| Business Fax Number: | |
| Mailing Address: | 2530 S Commerce St, ARDMORE |
| State: | OK |
| Postal Code: | 734015519 |
| Phone Number: | 5802235636 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2011 |
| NPI Last Update Date: | 02/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |