Healthcare Provider Details

I. General information

NPI: 1144320326
Provider Name (Legal Business Name): KAREN SHU-RA RAVEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W CREEK RD SUITE 20
INDEPENDENCE OH
44131-2139
US

IV. Provider business mailing address

6000 W CREEK RD SUITE 20
INDEPENDENCE OH
44131-2139
US

V. Phone/Fax

Practice location:
  • Phone: 216-986-1170
  • Fax: 216-986-1016
Mailing address:
  • Phone: 216-986-1170
  • Fax: 216-986-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE-1969
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: