Provider Demographics
NPI:1568795631
Name:RAY, KATHRYN A (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6467 GREENLAND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2437
Mailing Address - Country:US
Mailing Address - Phone:904-831-6992
Mailing Address - Fax:904-574-9377
Practice Address - Street 1:6467 GREENLAND RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2437
Practice Address - Country:US
Practice Address - Phone:904-574-9411
Practice Address - Fax:904-574-9377
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020335200Medicaid
FL9J5T6OtherBCBS
FL021021100Medicaid