Provider Demographics
NPI:1962038141
Name:RAYBURN, STEPHANIE (MFTC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2526
Mailing Address - Country:US
Mailing Address - Phone:970-988-6306
Mailing Address - Fax:
Practice Address - Street 1:2625 REDWING RD STE 175
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6324
Practice Address - Country:US
Practice Address - Phone:970-251-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist