MR. RAYMOND RICHARD PETTIS MS, LMHC
NPI 1073620753
Counselor - Mental Health in Waterloo, NY

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YM0800X and a focus in Mental Health.

Active since August 25, 2006

31 THURBER DR, WATERLOO, NY 13165(315) 539-1980(315) 539-1054 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Mr. Raymond Richard Pettis Ms, Lmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. RAYMOND RICHARD PETTIS MS, LMHC (NPI 1073620753) is an individual mental health provider in Waterloo, New York, licensed in New York (001185) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1073620753

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameMR. RAYMOND RICHARD PETTISCredential: MS, LMHC

Location Address31 THURBER DRWaterloo, NY 13165-1600

Mailing Address31 Thurber DrWaterloo, NY 13165-1600 · (315) 539-1980 · Fax (315) 539-1054

Phone(315) 539-1980

Fax(315) 539-1054

Sole ProprietorNo

Enumeration DateAugust 25, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1073620753 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in NY · 001185

31 THURBER DR, Waterloo, NY 13165

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Other Identifiers 1

Medicaid001185NY

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MARY P GRACE LCSW, CASAC, CPP

Social Worker (Clinical)