Provider Demographics
NPI:1922306471
Name:RAYMOND, JACOB E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:E
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 ONDREJKO RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1414
Mailing Address - Country:US
Mailing Address - Phone:724-880-7497
Mailing Address - Fax:
Practice Address - Street 1:933 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-5631
Practice Address - Country:US
Practice Address - Phone:304-554-2292
Practice Address - Fax:304-554-2249
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WV2126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health