Provider Demographics
NPI:1164041885
Name:RAYMO, HEATHER VALERIE (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:VALERIE
Last Name:RAYMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TOWN PLZ # 334
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5104
Mailing Address - Country:US
Mailing Address - Phone:970-903-8387
Mailing Address - Fax:
Practice Address - Street 1:1870 CR 135
Practice Address - Street 2:
Practice Address - City:HESPERUS
Practice Address - State:CO
Practice Address - Zip Code:81326
Practice Address - Country:US
Practice Address - Phone:970-903-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO009922231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical