Provider Demographics
NPI:1376238147
Name:RAY, LARRY LEE (SUDCC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:LEE
Last Name:RAY
Suffix:
Gender:M
Credentials:SUDCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S ATWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8302
Mailing Address - Country:US
Mailing Address - Phone:559-732-5550
Mailing Address - Fax:844-327-8496
Practice Address - Street 1:1845 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5423
Practice Address - Country:US
Practice Address - Phone:559-732-5550
Practice Address - Fax:884-327-8496
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14653101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)