Provider Demographics
NPI:1518735679
Name:RAYBURN, JAMES DANIEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DANIEL
Last Name:RAYBURN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 LOBLOLLY LN
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-4836
Mailing Address - Country:US
Mailing Address - Phone:912-216-2525
Mailing Address - Fax:
Practice Address - Street 1:236 LOBLOLLY LN
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-4836
Practice Address - Country:US
Practice Address - Phone:912-216-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist