Provider Demographics
NPI:1497926695
Name:RAVENSONG COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:RAVENSONG COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-616-1097
Mailing Address - Street 1:2900 SOUTH FRANK SCOTT PARKWAY WEST
Mailing Address - Street 2:SUITE 956 A
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-0044
Mailing Address - Country:US
Mailing Address - Phone:618-616-1097
Mailing Address - Fax:618-398-4095
Practice Address - Street 1:2900 SOUTH FRANK SCOTT PARKWAY WEST
Practice Address - Street 2:SUITE 956 A
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-0044
Practice Address - Country:US
Practice Address - Phone:618-616-1097
Practice Address - Fax:618-398-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty