Provider Demographics
NPI:1871789859
Name:RAYME, KELVIN BURNELL (LPC)
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:BURNELL
Last Name:RAYME
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 1:4826 COTTON RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-5330
Mailing Address - Country:US
Mailing Address - Phone:713-366-9424
Mailing Address - Fax:
Practice Address - Street 1:2656 S LOOP W STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2867
Practice Address - Country:US
Practice Address - Phone:713-366-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184864003Medicaid
TX184864002Medicaid