Healthcare Provider Details

I. General information

NPI: 1538792965
Provider Name (Legal Business Name): PATRICIA DIANE RAYA PH.D., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 N 95TH ST STE 101
SCOTTSDALE AZ
85258-4590
US

IV. Provider business mailing address

7349 N VIA PASEO DEL SUR # 515-254
SCOTTSDALE AZ
85258-3765
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-4247
  • Fax:
Mailing address:
  • Phone: 480-309-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18651
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: