Provider Demographics
NPI:1043608466
Name:RAYMOND, KERRI (LPC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20092
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7002
Mailing Address - Country:US
Mailing Address - Phone:307-630-4729
Mailing Address - Fax:307-369-4292
Practice Address - Street 1:1745 SILVER SPUR RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-1206
Practice Address - Country:US
Practice Address - Phone:307-630-4729
Practice Address - Fax:307-369-4292
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional