Provider Demographics
NPI:1578011797
Name:RAY OF HOPE LLC
Entity Type:Organization
Organization Name:RAY OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-580-1039
Mailing Address - Street 1:201 S LAKELINE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2719
Mailing Address - Country:US
Mailing Address - Phone:702-580-1039
Mailing Address - Fax:
Practice Address - Street 1:11300 W PARMER LN APT 1611
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4827
Practice Address - Country:US
Practice Address - Phone:702-580-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194944793Medicaid