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General NPI Number Information
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NPI Number | 1124460902
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Entity Type | Organization
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Legal Business Name | ERICA RAY, INC
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 15010 S RAVINIA AVE SUITE 15
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City | ORLAND PARK
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State | IL
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Zip | 60462-3162
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Country | US
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Telephone | 708-769-2097
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Fax |
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Provider Business Mailing Address
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Address Line | 3844 MARILYN DR
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City | RICHTON PARK
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State | IL
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Zip | 60471-1286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ERICA RAY
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Credential | MA
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Telephone | 708-769-2097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.005055
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License Number State | IL
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