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General NPI Number Information
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NPI Number | 1598589137
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Entity Type | Individual
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Provider Name | KOURTNEY SYMONE RAVEN LPC
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 104 W CLAYTON ST
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City | DAYTON
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State | TX
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Zip | 77535-2241
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Country | US
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Telephone | 936-262-7800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | DAYTON
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State | TX
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Zip | 77535-0001
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Country | US
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Telephone | 936-262-7800
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 93514
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License Number State | TX
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