Provider Demographics
NPI:1629775432
Name:RAVENEL, CHRISTINA LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEIGH
Last Name:RAVENEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-7527
Mailing Address - Country:US
Mailing Address - Phone:417-288-9139
Mailing Address - Fax:
Practice Address - Street 1:4201 W STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4782
Practice Address - Country:US
Practice Address - Phone:254-987-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86507OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS