Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1083730097 |
---|---|
Provider Name | Raymond Blackshire |
First Address | Los Angeles, CA 90013-2116 |
Second Address | Los Angeles, CA 90013-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 28/04/2009 |