Provider Demographics
NPI:1447379730
Name:RAY, JUDITH COPELIN (LPC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:COPELIN
Last Name:RAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50215
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-0215
Mailing Address - Country:US
Mailing Address - Phone:719-291-7156
Mailing Address - Fax:719-265-5607
Practice Address - Street 1:5265 N ACADEMY BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4082
Practice Address - Country:US
Practice Address - Phone:719-291-7156
Practice Address - Fax:719-265-5607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4539Medicare UPIN