Provider Demographics
NPI:1053615468
Name:RAPER, CAROL LOUISE (MA LMFT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:RAPER
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:CERRUDO-RAPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-0746
Mailing Address - Country:US
Mailing Address - Phone:541-247-4082
Mailing Address - Fax:541-247-5058
Practice Address - Street 1:29821 COLVIN ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-0746
Practice Address - Country:US
Practice Address - Phone:541-247-4082
Practice Address - Fax:541-247-5058
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health