Provider Demographics
NPI:1417425653
Name:RAY OF RESILIENCE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:RAY OF RESILIENCE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-983-8999
Mailing Address - Street 1:4940 S 114TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2377
Mailing Address - Country:US
Mailing Address - Phone:402-431-2835
Mailing Address - Fax:
Practice Address - Street 1:4940 S 114TH ST STE 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2377
Practice Address - Country:US
Practice Address - Phone:402-431-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty