Provider Demographics
NPI:1497239750
Name:RAY, KELLY M (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1532 LONE OAK RD STE 345
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7942
Mailing Address - Country:US
Mailing Address - Phone:270-444-2250
Mailing Address - Fax:270-538-6596
Practice Address - Street 1:1253 PARIS RD STE A
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-4989
Practice Address - Country:US
Practice Address - Phone:270-247-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY2532361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical