Provider Demographics
NPI:1043727605
Name:RAVEN WELLNESS LLC
Entity Type:Organization
Organization Name:RAVEN WELLNESS LLC
Other - Org Name:RAVEN WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:775-750-0766
Mailing Address - Street 1:1180 SELMI DR STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-4776
Mailing Address - Country:US
Mailing Address - Phone:775-750-0766
Mailing Address - Fax:775-323-1009
Practice Address - Street 1:1180 SELMI DR STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-4776
Practice Address - Country:US
Practice Address - Phone:775-750-0766
Practice Address - Fax:775-323-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty