Healthcare Provider Details

I. General information

NPI: 1780302695
Provider Name (Legal Business Name): ALLISON RAY MS, LMHC-D, NCC, ACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W GENESEE ST
CAMILLUS NY
13031-1499
US

IV. Provider business mailing address

144 FIRESIDE LN
CAMILLUS NY
13031-1931
US

V. Phone/Fax

Practice location:
  • Phone: 315-217-1232
  • Fax:
Mailing address:
  • Phone: 315-729-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: