Provider Demographics
NPI:1780302695
Name:RAY, ALLISON (MS, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FIRESIDE LN
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1931
Mailing Address - Country:US
Mailing Address - Phone:315-729-8492
Mailing Address - Fax:
Practice Address - Street 1:115 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2003
Practice Address - Country:US
Practice Address - Phone:315-400-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health