Provider Demographics
NPI:1255799888
Name:RAYMER, THERESA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:RAYMER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-7987
Mailing Address - Country:US
Mailing Address - Phone:425-241-0653
Mailing Address - Fax:
Practice Address - Street 1:499 SEAPORT CT STE 201
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2762
Practice Address - Country:US
Practice Address - Phone:425-241-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist