Provider Demographics
NPI:1639443047
Name:KAMMER, RAYMOND CHARLES (LAC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:KAMMER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2301 CUMBERLAND DR.
Mailing Address - Street 2:RECOVERY CENTER
Mailing Address - City:VALAPARISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-476-4676
Mailing Address - Fax:219-462-2381
Practice Address - Street 1:2301 CUMBERLAND DR
Practice Address - Street 2:RECOVERY CENTER
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2505
Practice Address - Country:US
Practice Address - Phone:219-476-4676
Practice Address - Fax:219-462-2381
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000133A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)