Provider Demographics
NPI:1770023582
Name:HAILEY RAY MA LPC
Entity Type:Organization
Organization Name:HAILEY RAY MA LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:806-831-5529
Mailing Address - Street 1:6202 IOLA AVE
Mailing Address - Street 2:SUITE #128
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2728
Mailing Address - Country:US
Mailing Address - Phone:806-831-5529
Mailing Address - Fax:
Practice Address - Street 1:6202 IOLA AVE
Practice Address - Street 2:SUITE #128
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2728
Practice Address - Country:US
Practice Address - Phone:806-831-5529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69003305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization