MEDICARE: GEETA RAVAL MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8484226	WI

General Provider Information

NPI Number	:	1629964671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEETA RAVAL MS

Provider Business Mailing Address
First Line	:	2119 N SUMMIT AVE APT 301
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1309
Country	:	US
Telephone Number	:	917-345-6556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1442 S 92ND ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4235
Country	:	US
Telephone Number	:	414-897-9467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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