Provider Demographics
NPI:1700501061
Name:RAY, TARA M (MA,NCC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:RAY
Suffix:
Gender:F
Credentials:MA,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W HIGHWAY 80 STE 1
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2897
Mailing Address - Country:US
Mailing Address - Phone:606-802-2880
Mailing Address - Fax:606-802-2888
Practice Address - Street 1:647 W HIGHWAY 80 STE 1
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2897
Practice Address - Country:US
Practice Address - Phone:606-802-2880
Practice Address - Fax:606-802-2888
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional