Provider Demographics
NPI:1467943340
Name:RAY, KAREN LYNN (MSC, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:RAY
Suffix:
Gender:F
Credentials:MSC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 E BASELINE RD STE E3
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1518
Mailing Address - Country:US
Mailing Address - Phone:480-296-3606
Mailing Address - Fax:
Practice Address - Street 1:2111 E BASELINE RD STE E3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1518
Practice Address - Country:US
Practice Address - Phone:480-296-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ14223751OtherCAQH CIGNA PROVIDER ID
AZ101YP2500XOtherTAXONOMY CODE