Healthcare Provider Details

I. General information

NPI: 1154036986
Provider Name (Legal Business Name): EDITH RAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E SAINT PETER ST
CARENCRO LA
70520-4008
US

IV. Provider business mailing address

238 BLUE RIDGE DR
CARENCRO LA
70520-5347
US

V. Phone/Fax

Practice location:
  • Phone: 337-692-2860
  • Fax: 800-370-1055
Mailing address:
  • Phone: 337-654-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9393
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: