Provider Demographics
NPI:1174276752
Name:RAYNES, NATALIE M (LMFT - IT)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:M
Last Name:RAYNES
Suffix:
Gender:F
Credentials:LMFT - IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 S PINEWOOD CREEK CT APT 106
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4365
Mailing Address - Country:US
Mailing Address - Phone:414-676-4808
Mailing Address - Fax:
Practice Address - Street 1:1002 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1808
Practice Address - Country:US
Practice Address - Phone:608-356-9055
Practice Address - Fax:608-268-9780
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI837-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174276752Other837-228