Provider Demographics
NPI:1205111267
Name:BLOTTIN, RAYMOND KEITH (LPC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:KEITH
Last Name:BLOTTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 421681
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78842-1681
Mailing Address - Country:US
Mailing Address - Phone:830-734-7340
Mailing Address - Fax:
Practice Address - Street 1:114 WEST LOSOYA
Practice Address - Street 2:SERENITY COUNSELING
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840
Practice Address - Country:US
Practice Address - Phone:830-734-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional