Provider Demographics
NPI:1265511778
Name:RAYBURN, BEVERLY TAYLOR (LPC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:TAYLOR
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 INDIANA AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2835
Mailing Address - Country:US
Mailing Address - Phone:806-783-0707
Mailing Address - Fax:
Practice Address - Street 1:8302 INDIANA AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2835
Practice Address - Country:US
Practice Address - Phone:806-783-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1787LCOtherBLUE CROSS BLUE SHIELD