Healthcare Provider Details

I. General information

NPI: 1215805551
Provider Name (Legal Business Name): LILLI M RAY COUNSELOR TRAINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E PERKINS AVE STE A
SANDUSKY OH
44870-7991
US

IV. Provider business mailing address

10318 COUNTY ROAD 312
BELLEVUE OH
44811-9655
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-6100
  • Fax:
Mailing address:
  • Phone: 419-217-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2607690-TRNE
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2607690-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: