Provider Information for 1760611636
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Mr. RAY JAMAAL HERNDON LCSW
Sex: Male
NPI: 1760611636
Last Updated: 2022-12-28
Certification Date: 2022-12-28
Certification Date: 2022-12-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1760611636 | ||||||||||||
| Enumeration Date | 2009-07-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 15555 COLORADO SPRINGS, CO 80935-5555 United States Phone: 909-912-5351 | Fax: | ||||||||||||
| Primary Practice Address | 1400 E BOULDER ST COLORADO SPRINGS, CO 80909-5533 United States Phone: 719-365-7505 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|