Healthcare Provider Details

I. General information

NPI: 1912039959
Provider Name (Legal Business Name): RAMIRO MENA RAYA JR. AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 BAILEY ST
HANFORD CA
93230-5922
US

IV. Provider business mailing address

1393 BAILEY ST
HANFORD CA
93230-5922
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-4481
  • Fax:
Mailing address:
  • Phone: 559-582-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF112151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: