Provider Demographics
NPI:1386193431
Name:RAY, SYREETA (COUNSLER)
Entity Type:Individual
Prefix:MRS
First Name:SYREETA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:COUNSLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 APACHE VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-5503
Mailing Address - Country:US
Mailing Address - Phone:303-250-6584
Mailing Address - Fax:
Practice Address - Street 1:4933 APACHE VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-5503
Practice Address - Country:US
Practice Address - Phone:303-250-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst