Basic Information
| Provider Information | |||||||||
| NPI: | 1487098752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2769 W RIVERWALK CIR | ||||||||
| Address2: | UNIT D | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801237103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704711258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12650 E BRIARWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801126792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204700578 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 03/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-21650 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.