Provider Demographics
NPI:1013211333
Name:HILLIS, RAYMOND EARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EARL
Last Name:HILLIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:SAGUACHE
Mailing Address - State:CO
Mailing Address - Zip Code:81149-0217
Mailing Address - Country:US
Mailing Address - Phone:505-412-0246
Mailing Address - Fax:
Practice Address - Street 1:1536 BISHOPS LODGE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-0005
Practice Address - Country:US
Practice Address - Phone:505-412-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2254101YM0800X
CO1486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health