Provider Demographics
NPI:1477989713
Name:O'ROURKE KEOHAN, RAVEN T (LCSW)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:T
Last Name:O'ROURKE KEOHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:TAYLOR
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:401 SOUTH MOUNT JULIET ROAD SUITE 235
Mailing Address - Street 2:#170
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3616
Mailing Address - Country:US
Mailing Address - Phone:615-285-9134
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LANE
Practice Address - Street 2:SUITE 37189
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204
Practice Address - Country:US
Practice Address - Phone:615-285-9134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5966101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health