Provider Demographics
NPI:1427530138
Name:RANEY, MACAYLA (MT-BC)
Entity type:Individual
Prefix:
First Name:MACAYLA
Middle Name:
Last Name:RANEY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAURENCE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2978
Mailing Address - Country:US
Mailing Address - Phone:423-779-4330
Mailing Address - Fax:
Practice Address - Street 1:1001 LAURENCE AVE STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2978
Practice Address - Country:US
Practice Address - Phone:423-779-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty