Provider Demographics
NPI:1932331576
Name:SUN RAY ADDICTIONS COUNSELING & EDUCATION, INC.
Entity Type:Organization
Organization Name:SUN RAY ADDICTIONS COUNSELING & EDUCATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYLEEN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC, CCS, CADC II
Authorized Official - Phone:951-652-3560
Mailing Address - Street 1:950 N STATE ST STE D
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1485
Mailing Address - Country:US
Mailing Address - Phone:951-652-3560
Mailing Address - Fax:951-929-2780
Practice Address - Street 1:950 N STATE ST STE D
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1485
Practice Address - Country:US
Practice Address - Phone:951-652-3560
Practice Address - Fax:951-929-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-16
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3339101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA333903Medicaid
CA333901Medicaid