Provider Demographics
NPI:1871688234
Name:SMITH, RAYMOND HARRY JR (MS,PPS,MFT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:HARRY
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MS,PPS,MFT
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT, ORDAINED
Mailing Address - Street 1:9613 OAKHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5116
Mailing Address - Country:US
Mailing Address - Phone:916-521-2677
Mailing Address - Fax:
Practice Address - Street 1:9613 OAKHAM WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757
Practice Address - Country:US
Practice Address - Phone:916-521-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health