Provider Demographics
NPI:1740399930
Name:RAYMOND, SALLY A (MFT)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:A
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FASANO WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4508
Mailing Address - Country:US
Mailing Address - Phone:805-682-1271
Mailing Address - Fax:805-682-1271
Practice Address - Street 1:11 FASANO WAY
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4508
Practice Address - Country:US
Practice Address - Phone:805-682-1271
Practice Address - Fax:805-682-1271
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist