MEDICARE: RAVEN WASHINGTON

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	225C00000X	Rehabilitation Counselor	00278994	LA
2	101YP2500X	Professional Counselor	90491	TX

General Provider Information

NPI Number	:	1740035716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN WASHINGTON

Provider Business Mailing Address
First Line	:	2303 MID LN APT 314
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3852
Country	:	US
Telephone Number	:	225-223-5702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 MID LN APT 314
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3852
Country	:	US
Telephone Number	:	225-223-5702
Fax Number	:

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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Directions to “ RAVEN WASHINGTON ” Practice Location

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