Provider Demographics
NPI:1245403112
Name:RAY, JODY MARIE
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 ROUGHING IT RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-9745
Mailing Address - Country:US
Mailing Address - Phone:775-352-6840
Mailing Address - Fax:
Practice Address - Street 1:104 BIG BEND RANCH ROAD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:NV
Practice Address - Zip Code:89442
Practice Address - Country:US
Practice Address - Phone:775-352-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01212-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV01212-LOtherLICENSED SUBSTANCE ABUSE COUNSELOR