Provider Demographics
NPI:1679314900
Name:BOOKER, RAYMOND LEE I (MA, LPCC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LEE
Last Name:BOOKER
Suffix:I
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7426 CHERRY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4263
Mailing Address - Country:US
Mailing Address - Phone:909-202-5024
Mailing Address - Fax:
Practice Address - Street 1:4401 ATLANTIC AVE STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2264
Practice Address - Country:US
Practice Address - Phone:909-287-5056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT146599101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor