Provider Demographics
NPI:1417964008
Name:RAYBURN, DEBORAH (LPC, CADC III)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:LPC, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 N JANACEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-641-9050
Mailing Address - Fax:262-641-9126
Practice Address - Street 1:N84W15787 MENOMONEE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3081
Practice Address - Country:US
Practice Address - Phone:262-255-5571
Practice Address - Fax:262-255-5581
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13266101YA0400X
WI3402-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40970200Medicaid