Provider Demographics
NPI:1821489386
Name:RAY, DYANN (, BACHELOR)
Entity Type:Individual
Prefix:
First Name:DYANN
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:, BACHELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2634
Mailing Address - Country:US
Mailing Address - Phone:602-599-5434
Mailing Address - Fax:602-599-5734
Practice Address - Street 1:402 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2031
Practice Address - Country:US
Practice Address - Phone:575-746-8756
Practice Address - Fax:575-622-3325
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker