Healthcare Provider Details

I. General information

NPI: 1407723299
Provider Name (Legal Business Name): ELISE RAYMOND MA, PPS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S VILLA AVE
WILLOWS CA
95988-2959
US

IV. Provider business mailing address

1408 63RD ST
SACRAMENTO CA
95819-4314
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-6575
  • Fax:
Mailing address:
  • Phone: 916-539-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: