Provider Demographics
NPI:1790243350
Name:RAY, CARTER (CBT)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:716 MT BAKER AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4835
Mailing Address - Country:US
Mailing Address - Phone:206-949-7640
Mailing Address - Fax:425-572-0653
Practice Address - Street 1:716 MT BAKER AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4835
Practice Address - Country:US
Practice Address - Phone:206-949-7640
Practice Address - Fax:425-572-0653
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60939206106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician