Healthcare Provider Details

I. General information

NPI: 1104522655
Provider Name (Legal Business Name): SARAH RAY CLINICAL PSYCHOLOGIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12396 WORLD TRADE DR STE 213
SAN DIEGO CA
92128-3792
US

IV. Provider business mailing address

12396 WORLD TRADE DR STE 213
SAN DIEGO CA
92128-3792
US

V. Phone/Fax

Practice location:
  • Phone: 619-281-6414
  • Fax: 619-359-4326
Mailing address:
  • Phone: 619-281-6414
  • Fax: 619-359-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARAH L RAY
Title or Position: CEO / OWNER
Credential: PSYD
Phone: 619-281-6414