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General NPI Number Information
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NPI Number | 1457407264
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Entity Type | Individual
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Provider Name | ANGELYN RAY LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 100 N. D STREET OFFICE # 208 THE MARIUS BUILDING,
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City | LAKEVIEW
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State | OR
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Zip | 97630-0000
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Country | US
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Telephone | 541-417-1074
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Fax | 541-947-0138
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Provider Business Mailing Address
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Address Line | PO BOX 1206
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City | LAKEVIEW
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State | OR
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Zip | 97630-0047
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Country | US
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Telephone | 541-417-1074
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Fax | 541-947-0138
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2450
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License Number State | OR
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