Provider Demographics
NPI:1881570802
Name:WHITE, RAY MARIN (MA, LPC)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:MARIN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 N SHERIDAN RD APT 221
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5483
Mailing Address - Country:US
Mailing Address - Phone:217-649-0636
Mailing Address - Fax:
Practice Address - Street 1:4711 N BROADWAY ST STE 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4908
Practice Address - Country:US
Practice Address - Phone:773-377-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health