Provider Demographics
NPI:1851792410
Name:RAY, ROBERT (PHD, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:PHD, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 FOREST PARK CIR STE 206
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3485
Mailing Address - Country:US
Mailing Address - Phone:303-349-5420
Mailing Address - Fax:
Practice Address - Street 1:1369 FOREST PARK CIR
Practice Address - Street 2:SUITE 207
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3201
Practice Address - Country:US
Practice Address - Phone:303-349-5420
Practice Address - Fax:303-500-6189
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD-233101YA0400X
COLPC-11346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)