Provider Demographics
NPI:1639413917
Name:RAYNES, AMY C (PC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:RAYNES
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 STATE ROUTE 127 N
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9289
Mailing Address - Country:US
Mailing Address - Phone:937-456-1915
Mailing Address - Fax:
Practice Address - Street 1:2172 STATE ROUTE 127 N
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9289
Practice Address - Country:US
Practice Address - Phone:937-456-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional