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General NPI Number Information
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NPI Number | 1427487792
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Entity Type | Individual
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Provider Name | NICOLE RAY
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 850 76TH ST RM B101-G
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City | NEWAYGO
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State | MI
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Zip | 49337-7930
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Country | US
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Telephone | 231-652-3587
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Fax | 231-652-5963
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Provider Business Mailing Address
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Address Line | 520 COBB ST
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City | CADILLAC
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State | MI
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Zip | 49601-2588
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Country | US
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Telephone | 231-876-6527
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Fax | 231-876-6721
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401011277
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License Number State | MI
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