MEDICARE: MRS. ANDREA RAY LMHC, SUDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00002514	WA
2	101YM0800X	Mental Health Counselor	LH00007805	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831242908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA RAY LMHC, SUDP

Provider Business Mailing Address
First Line	:	7409 W GRANDRIDGE BLVD STE 101
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-6710
Country	:	US
Telephone Number	:	509-554-6721
Fax Number	:	509-357-8646

Provider Business Practice Location Address
First Line	:	7409 W GRANDRIDGE BLVD STE 101
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-6710
Country	:	US
Telephone Number	:	208-503-3698
Fax Number	:	509-357-8646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	10/29/2019

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