Provider Demographics
NPI:1104613199
Name:RAYON, MANDY LYNN
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:RAYON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9827 W ETIENNE RD
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-3210
Mailing Address - Country:US
Mailing Address - Phone:337-322-3208
Mailing Address - Fax:
Practice Address - Street 1:9827 W ETIENNE RD
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-3210
Practice Address - Country:US
Practice Address - Phone:337-322-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARBT-24-371703106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician