Provider Demographics
NPI:1326369067
Name:MARS, RAYMOND
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:MARS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:
Other - Last Name:MARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5701 W SLAUSON AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6523
Mailing Address - Country:US
Mailing Address - Phone:323-447-6194
Mailing Address - Fax:
Practice Address - Street 1:5701 W SLAUSON AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6523
Practice Address - Country:US
Practice Address - Phone:323-447-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17945103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling