MEDICARE: MR. JOSEPH W RAVAN JR. LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227900000X	Registered Respiratory Therapist	RCP4566	SC
2	101YP2500X	Professional Counselor	6278	SC

General Provider Information

NPI Number	:	1679997829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH W RAVAN JR. LPC

Provider Business Mailing Address
First Line	:	405A E 1ST AVE
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3062
Country	:	US
Telephone Number	:	864-437-3703
Fax Number	:

Provider Business Practice Location Address
First Line	:	405A E 1ST AVE
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3062
Country	:	US
Telephone Number	:	864-644-8251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	04/25/2016

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