MEDICARE: MS. DEDRA D RAYMOND

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	251E00000X	Home Health Agency
4	251S00000X	Community/Behavioral Health Agency	TX

General Provider Information

NPI Number	:	1518422195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEDRA D RAYMOND

Provider Business Mailing Address
First Line	:	1505 HIGHWAY 6 S STE 270B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1700
Country	:	US
Telephone Number	:	832-775-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 HIGHWAY 6 S STE 270B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1700
Country	:	US
Telephone Number	:	832-775-3493
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	07/21/2022

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