Provider Demographics
NPI:1093386112
Name:RAYMOND, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E BROADWAY CT STE E
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7931
Mailing Address - Country:US
Mailing Address - Phone:918-245-5565
Mailing Address - Fax:
Practice Address - Street 1:401 E BROADWAY CT STE E
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7931
Practice Address - Country:US
Practice Address - Phone:918-245-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional