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General NPI Number Information
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NPI Number | 1366261877
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Entity Type | Individual
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Provider Name | HEIDI LEANNE RAYMOND
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1646 S COURT ST
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City | VISALIA
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State | CA
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Zip | 93277-4962
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Country | US
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Telephone | 559-586-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 16196 HOUSTON RD
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City | LEMOORE
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State | CA
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Zip | 93245-9548
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Country | US
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Telephone | 707-483-6354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1516620723
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License Number State | CA
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