Healthcare Provider Details

I. General information

NPI: 1316095870
Provider Name (Legal Business Name): RAYMOND ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

IV. Provider business mailing address

PO BOX 6094
SANTA FE NM
87502-6094
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-0010
  • Fax:
Mailing address:
  • Phone: 505-438-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3760
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0087421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: