Provider Demographics
NPI:1093359937
Name:RAYMOND, SHIRA (CCHT)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 W STELLA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1813
Mailing Address - Country:US
Mailing Address - Phone:480-719-5535
Mailing Address - Fax:
Practice Address - Street 1:5320 N 16TH ST STE 209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3242
Practice Address - Country:US
Practice Address - Phone:480-719-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health