Provider Demographics
NPI:1457407264
Name:RAY, ANGELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELYN
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
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 1206
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-0047
Mailing Address - Country:US
Mailing Address - Phone:541-417-1074
Mailing Address - Fax:541-947-0138
Practice Address - Street 1:100 N. D STREET
Practice Address - Street 2:OFFICE # 208 THE MARIUS BUILDING,
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-0000
Practice Address - Country:US
Practice Address - Phone:541-417-1074
Practice Address - Fax:541-947-0138
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical