Provider Demographics
NPI:1669801775
Name:RAY, KATHLEEN LYNNE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LYNNE
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 ONDORO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4212
Mailing Address - Country:US
Mailing Address - Phone:702-878-2040
Mailing Address - Fax:888-575-8185
Practice Address - Street 1:4631 ONDORO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4212
Practice Address - Country:US
Practice Address - Phone:702-878-2040
Practice Address - Fax:888-575-8185
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor