Provider Demographics
NPI:1033943972
Name:RAYMOND, NICHOLE RENEE (QMHP)
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:RENEE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:RENEE
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3485 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3810
Mailing Address - Country:US
Mailing Address - Phone:775-842-9883
Mailing Address - Fax:
Practice Address - Street 1:150 SHELTON MCMURPHEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5015
Practice Address - Country:US
Practice Address - Phone:541-210-8090
Practice Address - Fax:541-210-5310
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health