Provider Demographics
NPI:1871461392
Name:RAY, KOLBY JASON
Entity type:Individual
Prefix:
First Name:KOLBY
Middle Name:JASON
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 1:3125 SUGAR LEO RD APT B
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7932
Mailing Address - Country:US
Mailing Address - Phone:435-375-9292
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E STE D1
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2576
Practice Address - Country:US
Practice Address - Phone:435-705-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health