Provider Demographics
NPI:1962936161
Name:RAY, JEFFERY BENNETT (CO60538724)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:BENNETT
Last Name:RAY
Suffix:
Gender:
Credentials:CO60538724
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 POWELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2908
Mailing Address - Country:US
Mailing Address - Phone:425-277-1311
Mailing Address - Fax:425-277-1566
Practice Address - Street 1:126 AUBURN AVE STE 300
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5082
Practice Address - Country:US
Practice Address - Phone:253-735-0166
Practice Address - Fax:253-253-3222
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO 60538724101Y00000X
WACP60671924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor