Individual provider Active NPI

Susan Jill Ray, LMFT

  • Marriage & Family Therapist
  • Kailua, HI
National Provider Identifier
1013089671
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT 109 Issued in HI
Practice address
970 N Kalaheo Ave Ste A212
Kailua, HI 96734-1857
Phone
(808) 227-6791
Fax
(808) 744-8322
NPI assigned
Nov 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT-109 HI
Marriage & Family Therapist 106H00000X MFT 109 HI Primary

Addresses

Primary practice location

970 N Kalaheo Ave Ste A212
Kailua, HI 96734-1857

Mailing address

442 Kalama St
Kailua, HI 96734-2045
Phone (808) 227-6791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240508001126 HI Practitioner - Marriage and Family Therapist 2860833852 Practice locations: Kailua, HI

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MFT 109HIMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1013089671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 KALAMA ST",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342045",
            "telephone_number": "808-227-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 N KALAHEO AVE STE A212",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967341857",
            "telephone_number": "808-227-6791",
            "fax_number": "808-744-8322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "SUSAN",
        "middle_name": "JILL",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT-109",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT 109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua, HI

Sources for this page

Verify at the official NPI Registry.