Provider Demographics
NPI:1013072164
Name:KAMOO, RAY (PHD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:KAMOO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30200 TELEGRAPH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5711
Mailing Address - Country:US
Mailing Address - Phone:248-712-1129
Mailing Address - Fax:248-792-3249
Practice Address - Street 1:30200 TELEGRAPH RD STE 207
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5711
Practice Address - Country:US
Practice Address - Phone:248-712-1129
Practice Address - Fax:248-792-3249
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822164103TA0400X
MI6301007666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)