Healthcare Provider Details

I. General information

NPI: 1972443729
Provider Name (Legal Business Name): RAVEN WINSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MURRAY GUARD DR
JACKSON TN
38305-3610
US

IV. Provider business mailing address

39 MURRAY GUARD DR
JACKSON TN
38305-3610
US

V. Phone/Fax

Practice location:
  • Phone: 731-736-4400
  • Fax:
Mailing address:
  • Phone: 731-736-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: