MEDICARE: MR. RAYMOND L GRUBBS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	650	NC
2	106H00000X	Marriage & Family Therapist	650	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12622	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1265422539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND L GRUBBS LMFT

Provider Business Mailing Address
First Line	:	1515 MOCKINGBIRD LN
Second Line	:	SUITE 412
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3236
Country	:	US
Telephone Number	:	704-523-5252
Fax Number	:	704-523-5251

Provider Business Practice Location Address
First Line	:	1515 MOCKINGBIRD LN
Second Line	:	SUITE 412
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3236
Country	:	US
Telephone Number	:	704-523-5252
Fax Number	:	704-523-5251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/11/2025

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