Healthcare Provider Details

I. General information

NPI: 1811404460
Provider Name (Legal Business Name): RAVEN MICOLE LINDO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE 590
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

4000 W METROPOLITAN DR
ORANGE CA
92868-3504
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6117
  • Fax:
Mailing address:
  • Phone: 866-830-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC6582
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: