Provider Demographics
NPI:1134540784
Name:RAINES, KATHLEEN (LMHC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 S EAST ST
Mailing Address - Street 2:SUITE A5
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1994
Mailing Address - Country:US
Mailing Address - Phone:317-478-7911
Mailing Address - Fax:
Practice Address - Street 1:5226 S EAST ST
Practice Address - Street 2:SUITE A5
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1994
Practice Address - Country:US
Practice Address - Phone:317-478-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002551A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health