MEDICARE: RAYMER PSYCHOTHERAPY & CONSULTATION INC.

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	1041C0700X	Clinical Social Worker	680101688	MI

General Provider Information

NPI Number	:	1770884850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYMER PSYCHOTHERAPY & CONSULTATION INC.

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	ACME
State	:	MI
Zip	:	49610-0105
Country	:	US
Telephone Number	:	231-938-9610
Fax Number	:	231-938-9818

Provider Business Practice Location Address
First Line	:	6652 DEEPWATER POINT RD
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9247
Country	:	US
Telephone Number	:	231-938-9610
Fax Number	:	231-938-9818

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY RAYMER
Credential	:	LMSW, ACSW
Telephone Number	:	231-938-9610

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	01/28/2011

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