Provider Demographics
NPI:1972070274
Name:RAY, LELAH (MA, CADC)
Entity Type:Individual
Prefix:
First Name:LELAH
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N MILL ST STE 800
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1381
Mailing Address - Country:US
Mailing Address - Phone:217-330-9587
Mailing Address - Fax:
Practice Address - Street 1:235 N MILL ST STE 800
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1381
Practice Address - Country:US
Practice Address - Phone:217-330-9587
Practice Address - Fax:217-706-5717
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)