Healthcare Provider Details

I. General information

NPI: 1538884754
Provider Name (Legal Business Name): LIZA MARIE RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY STE 301
TACOMA WA
98402-4454
US

IV. Provider business mailing address

11170 PET HAVEN PL NW
SILVERDALE WA
98383-4506
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-4354
  • Fax:
Mailing address:
  • Phone: 240-270-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61579234
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61371145
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61367335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: