Provider Demographics
NPI:1215188289
Name:RAYNOR, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15336
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-5336
Mailing Address - Country:US
Mailing Address - Phone:209-613-9514
Mailing Address - Fax:
Practice Address - Street 1:1511 19TH ST.
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445
Practice Address - Country:US
Practice Address - Phone:209-613-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist