Provider Demographics
NPI:1366285330
Name:RAYMOND, CATHERINE LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LOUISE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E ORANGE GROVE RD APT 223
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5555
Mailing Address - Country:US
Mailing Address - Phone:520-971-2113
Mailing Address - Fax:
Practice Address - Street 1:11 E ORANGE GROVE RD APT 223
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5555
Practice Address - Country:US
Practice Address - Phone:520-971-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional