Provider Demographics
NPI:1659415750
Name:RAY, KENNETH ALBERT (DBH, MED)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALBERT
Last Name:RAY
Suffix:
Gender:M
Credentials:DBH, MED
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 1481
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1481
Mailing Address - Country:US
Mailing Address - Phone:606-694-3031
Mailing Address - Fax:
Practice Address - Street 1:4200 WOODHAVEN CT
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5781
Practice Address - Country:US
Practice Address - Phone:606-694-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011229102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-4220408OtherIRS
274220406OtherIRS