Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 4088 | AZ |
Y | 103TC0700X | Clinical Psychologist | 4088 | AZ |
NPI | 1003131848 |
---|---|
Provider Name | Colleen Andrea Ray |
First Address | Tucson, AZ 85715-3477 |
Second Address | Tucson, AZ 85715-3477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 05/04/2010 |