Provider Demographics
NPI:1932609211
Name:RAY, MAX ROBERT II (LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:ROBERT
Last Name:RAY
Suffix:II
Gender:M
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1005
Mailing Address - Country:US
Mailing Address - Phone:614-766-0161
Mailing Address - Fax:
Practice Address - Street 1:1434 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1005
Practice Address - Country:US
Practice Address - Phone:614-766-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162355101YA0400X
OHC.2204660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)