Provider Demographics
NPI:1093540320
Name:RAY-RUCKER, CLARISSE YVETTE (MS)
Entity type:Individual
Prefix:
First Name:CLARISSE
Middle Name:YVETTE
Last Name:RAY-RUCKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMPREHENSIVE PSYCHIATRY GROUP, INC.
Mailing Address - Street 2:955 WINDHAM CT., SUITE 2
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5035
Mailing Address - Country:US
Mailing Address - Phone:330-726-9570
Mailing Address - Fax:330-726-9031
Practice Address - Street 1:COMPREHENSIVE PSYCHIATRY GROUP, INC.
Practice Address - Street 2:955 WINDHAM CT., SUITE 2
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5035
Practice Address - Country:US
Practice Address - Phone:330-726-9570
Practice Address - Fax:330-726-9031
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405944-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor