Provider Demographics
NPI:1043495294
Name:LEDOUX, RAYMOND LOUIS (PHD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LOUIS
Last Name:LEDOUX
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 1:820 BAY AVE
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2140
Mailing Address - Country:US
Mailing Address - Phone:831-476-6582
Mailing Address - Fax:831-476-6582
Practice Address - Street 1:820 BAY AVE
Practice Address - Street 2:SUITE 203B
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2140
Practice Address - Country:US
Practice Address - Phone:831-476-6582
Practice Address - Fax:831-476-6582
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMY16411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health