Provider Demographics
NPI:1487964292
Name:RAYMOND, MARK APOLLO (LPC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:APOLLO
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 KINGWOOD DR # 231
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4473
Mailing Address - Country:US
Mailing Address - Phone:210-385-1897
Mailing Address - Fax:
Practice Address - Street 1:526 KINGWOOD DR # 231
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4473
Practice Address - Country:US
Practice Address - Phone:210-385-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66416OtherTEXAS STATE BOARD