Healthcare Provider Details

I. General information

NPI: 1659315406
Provider Name (Legal Business Name): RAYMOND SCOTT STATHAM L.P.C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SPRINGHILL AVE VA OPC
MOBILE AL
36604-3207
US

IV. Provider business mailing address

711 CEDAR AVE
FAIRHOPE AL
36532-2840
US

V. Phone/Fax

Practice location:
  • Phone: 251-219-3701
  • Fax:
Mailing address:
  • Phone: 251-990-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number293
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22218
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2309
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1570
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: