Healthcare Provider Details

I. General information

NPI: 1467390427
Provider Name (Legal Business Name): GAEA RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W CALDWELL ST
COMPTON CA
90220-4116
US

IV. Provider business mailing address

2436 E 4TH ST # 503
LONG BEACH CA
90814-1156
US

V. Phone/Fax

Practice location:
  • Phone: 310-639-4321
  • Fax:
Mailing address:
  • Phone: 562-270-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number140960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: