Provider Demographics
NPI:1659516805
Name:RAY, JEFFREY LEWIS (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:RAY
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4398
Mailing Address - Country:US
Mailing Address - Phone:850-293-0702
Mailing Address - Fax:
Practice Address - Street 1:3320 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4398
Practice Address - Country:US
Practice Address - Phone:850-293-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health