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General NPI Number Information
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NPI Number | 1770299968
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Entity Type | Organization
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Legal Business Name | RAVEN, LOTUS & GREY, PLLC
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 201 E SOUTH TEMPLE APT 133
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1294
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Country | US
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Telephone | 630-338-5893
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E SOUTH TEMPLE APT 133
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | AMY PERRY
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Credential | CMHC, NCC
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Telephone | 630-338-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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