Provider Demographics
NPI:1770793887
Name:HOMMES, RAYMOND E (MFT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:E
Last Name:HOMMES
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 1:1175 W BASELINE RD
Mailing Address - Street 2:UNIT 20
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2146
Mailing Address - Country:US
Mailing Address - Phone:909-625-7507
Mailing Address - Fax:
Practice Address - Street 1:51 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5243
Practice Address - Country:US
Practice Address - Phone:909-793-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist