1588709760 NPI number — COURTNEY WILLIAM RAY LCSW C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588709760 NPI number — COURTNEY WILLIAM RAY LCSW C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RAY

Provider First Name:

COURTNEY

Provider Middle Name:

WILLIAM

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

LCSW C

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1588709760

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/01/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4500 GROSS MILL RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HAMPSTEAD

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21074-2519

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-374-4021

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

10784 HICKORY RIDGE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COLUMBIA

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21044-3646

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-992-7288

Provider Business Practice Location Address Fax Number:

410-997-2880

Provider Enumeration Date:

02/21/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 104100000X , with the licence number:  11545 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 266716000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".
• Identifier: 275253 . This is a "MAMSI OPTIMUM CHOICE MDIP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 332149 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 7644295 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 226613 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
• Identifier: 486959300 . This is a "DIVISION OF FEDERAL EMPLO" identifier . This identifiers is of the category "OTHER".
• Identifier: 61657401 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: PVPB149968 . This is a "AMERICANPSYCH SYSTEMS" identifier . This identifiers is of the category "OTHER".
• Identifier: 001498578002 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 163543 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
• Identifier: 9255119 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
• Identifier: H1240011 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".