Provider Demographics
NPI:1053905299
Name:RAY, JASON M (CPRC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:M
Last Name:RAY
Suffix:
Gender:M
Credentials:CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9515
Mailing Address - Country:US
Mailing Address - Phone:906-458-3225
Mailing Address - Fax:
Practice Address - Street 1:501 LAKEWOOD LN
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9515
Practice Address - Country:US
Practice Address - Phone:906-458-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)