Provider Demographics
NPI:1003987843
Name:RAY, JEANNINE JOYCE (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:JOYCE
Last Name:RAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:J
Other - Last Name:EMADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD(C)
Mailing Address - Street 1:229 NEWBURY WAY
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-4228
Mailing Address - Country:US
Mailing Address - Phone:707-881-7570
Mailing Address - Fax:707-648-0393
Practice Address - Street 1:229 NEWBURY WAY
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-4228
Practice Address - Country:US
Practice Address - Phone:707-881-7570
Practice Address - Fax:707-648-0393
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77516106H00000X
OHF1100006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist