Healthcare Provider Details

I. General information

NPI: 1013211333
Provider Name (Legal Business Name): RAYMOND EARL HILLIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 BISHOPS LODGE RD
SANTA FE NM
87506-0005
US

IV. Provider business mailing address

PO BOX 217
SAGUACHE CO
81149-0217
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-0246
  • Fax:
Mailing address:
  • Phone: 505-412-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2254
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1486
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: