Provider Demographics
NPI:1811495807
Name:RAY, KAKA LYN (LMFT)
Entity type:Individual
Prefix:
First Name:KAKA
Middle Name:LYN
Last Name:RAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 BRYAN PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4935
Mailing Address - Country:US
Mailing Address - Phone:615-568-0784
Mailing Address - Fax:
Practice Address - Street 1:5409 MARYLAND WAY STE 305
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1035
Practice Address - Country:US
Practice Address - Phone:615-589-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TN101YP2500X
TN0611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE