Basic Information
| Provider Information | |||||||||
| NPI: | 1194998740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | BEA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAYMOND | ||||||||
| OtherFirstName: | BEATRICE | ||||||||
| OtherMiddleName: | CHRISLEY | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5022 N 54TH AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853017531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239314343 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5022 N 54TH AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853017531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239314343 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2008 | ||||||||
| LastUpdateDate: | 04/03/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC-10601 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.