Provider Demographics
NPI:1962834028
Name:KILLIPS, RAYMOND EDWARD (MFT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:EDWARD
Last Name:KILLIPS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 N CUYAMACA ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23981 SHERILTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:DESCANSO
Practice Address - State:CA
Practice Address - Zip Code:91916-9740
Practice Address - Country:US
Practice Address - Phone:619-445-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist