Provider Demographics
NPI:1114079043
Name:STODDARD, RAYMOND DEAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:DEAN
Last Name:STODDARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 JAMESON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1431
Mailing Address - Country:US
Mailing Address - Phone:806-433-6019
Mailing Address - Fax:
Practice Address - Street 1:7413 JAMESON DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1431
Practice Address - Country:US
Practice Address - Phone:806-433-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59428OtherLPC