Provider Demographics
NPI:1184081614
Name:MCCRAY, JAMES (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7525
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-0525
Mailing Address - Country:US
Mailing Address - Phone:530-318-2131
Mailing Address - Fax:866-899-6977
Practice Address - Street 1:1620 N CARPENTER RD STE D59
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1148
Practice Address - Country:US
Practice Address - Phone:530-318-2131
Practice Address - Fax:866-899-6977
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist