Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 2254 | NM |
Y | 102L00000X | Psychologist | 1486 | CO |
Y | 103T00000X | Psychologist | 1486 | CO |
NPI | 1013211333 |
---|---|
Provider Name | Dr. Raymond Earl Hillis |
First Address | Saguache, CO 81149-0217 |
Second Address | Santa Fe, NM 87506-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2010 |
Last Update Date | 29/12/2010 |