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General NPI Number Information
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NPI Number | 1780911347
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Entity Type | Organization
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Legal Business Name | RAVEN COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 8625 GOLF COURSE RD NW STE B2
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5114
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Country | US
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Telephone | 505-508-0808
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Fax | 888-896-8728
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Provider Business Mailing Address
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Address Line | 8625 GOLF COURSE RD NW STE B2
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5114
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Country | US
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Telephone | 505-508-0808
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Fax | 888-896-8728
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Authorized Official
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Title or Position | BILLING & NETWORK
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Name | TANYA MEDINA
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Credential | CPB-COC
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Telephone | 505-508-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0100131
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License Number State | NM
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