Provider Demographics
NPI:1770884850
Name:RAYMER PSYCHOTHERAPY & CONSULTATION INC.
Entity type:Organization
Organization Name:RAYMER PSYCHOTHERAPY & CONSULTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW
Authorized Official - Phone:231-938-9610
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-0105
Mailing Address - Country:US
Mailing Address - Phone:231-938-9610
Mailing Address - Fax:231-938-9818
Practice Address - Street 1:6652 DEEPWATER POINT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9247
Practice Address - Country:US
Practice Address - Phone:231-938-9610
Practice Address - Fax:231-938-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0890494Medicare PIN