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General NPI Number Information
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NPI Number | 1174217673
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Entity Type | Individual
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Provider Name | RAVEN MARIE VANHOUTEN CDCAP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 7807 STATE ROUTE 309 LOT 1
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City | GALION
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State | OH
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Zip | 44833-9752
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Country | US
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Telephone | 419-566-2891
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Fax | 567-393-9480
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Provider Business Mailing Address
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Address Line | PO BOX 877
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City | GALION
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State | OH
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Zip | 44833-0877
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Country | US
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Telephone | 419-566-2891
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Fax | 567-393-9480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.184667
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License Number State | OH
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