Provider Demographics
NPI:1881981421
Name:RAY, TARRA LYNN WINFIELD (LLPC)
Entity type:Individual
Prefix:MRS
First Name:TARRA
Middle Name:LYNN WINFIELD
Last Name:RAY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0426
Mailing Address - Country:US
Mailing Address - Phone:517-980-5648
Mailing Address - Fax:
Practice Address - Street 1:2025 S. WASHINGTON
Practice Address - Street 2:SUITE 210
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-371-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional