Provider Information for 1649691544
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KRISTL JORDAINE BRAY BCBA, LCSW
Sex: Female
NPI: 1649691544
Last Updated: 2025-01-15
Certification Date: 2025-01-15
Certification Date: 2025-01-15
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1649691544 | ||||||||||||||||
| Enumeration Date | 2013-12-18 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 317 4TH AVE SE CUT BANK, MT 59427-3607 United States Phone: 801-641-4420 | Fax: | ||||||||||||||||
| Primary Practice Address | 317 4TH AVE SE CUT BANK, MT 59427-3607 United States Phone: 801-268-4887 | Fax: | ||||||||||||||||
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