Provider Demographics
NPI:1487098752
Name:RAY, MICHAEL C
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:RAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 W RIVERWALK CIR
Mailing Address - Street 2:UNIT D
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7103
Mailing Address - Country:US
Mailing Address - Phone:970-471-1258
Mailing Address - Fax:
Practice Address - Street 1:12650 E BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6792
Practice Address - Country:US
Practice Address - Phone:720-470-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-21650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst