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NPI Code Detail

MEDICARE: LILY RAYMOND PHD

MEDICARE:   LILY  RAYMOND  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist01561MO

General Provider Information

NPI Number : 1275610453
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILY RAYMOND PHD
Provider Business Mailing Address
First Line : 416 EDGEWOOD DR
Second Line :
City : CLAYTON
State : MO
Zip : 63105-2016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5300 ARSENAL ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63139-1463
Country : US
Telephone Number : 314-877-6132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/17/2008

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