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General NPI Number Information
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NPI Number | 1831242908
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Entity Type | Individual
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Provider Name | ANDREA RAY LMHC, SUDP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 7409 W GRANDRIDGE BLVD STE 101
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City | KENNEWICK
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State | WA
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Zip | 99336-6710
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Country | US
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Telephone | 208-503-3698
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Fax | 509-357-8646
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Provider Business Mailing Address
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Address Line | 7409 W GRANDRIDGE BLVD STE 101
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City | KENNEWICK
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State | WA
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Zip | 99336-6710
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Country | US
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Telephone | 509-554-6721
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Fax | 509-357-8646
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00002514
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00007805
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License Number State | WA
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