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General NPI Number Information
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NPI Number | 1770460883
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Entity Type | Individual
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Provider Name | RAVEN LYNN JUERGENSEN APCC, ATR-P
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 2904 W SUNSET BLVD STE 6
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City | LOS ANGELES
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State | CA
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Zip | 90026-7308
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Country | US
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Telephone | 213-534-7013
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 N ADAMSON ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-7082
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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 |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC19492
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License Number State | CA
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