Provider Demographics
NPI:1831637560
Name:RAYBURN, ELEONORE OTTILIE (LMHC)
Entity Type:Individual
Prefix:
First Name:ELEONORE
Middle Name:OTTILIE
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WEST SADIE STREET
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510
Mailing Address - Country:US
Mailing Address - Phone:813-438-5949
Mailing Address - Fax:813-438-5951
Practice Address - Street 1:306 W SADIE ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4440
Practice Address - Country:US
Practice Address - Phone:813-438-5949
Practice Address - Fax:813-438-5951
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health