Provider Demographics
NPI:1689829756
Name:RAVEN, MICHAEL C (BSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:RAVEN
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
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Mailing Address - Street 1:535 PRESTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6532
Mailing Address - Country:US
Mailing Address - Phone:214-941-0798
Mailing Address - Fax:214-941-0408
Practice Address - Street 1:628 CENTRE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6328
Practice Address - Country:US
Practice Address - Phone:214-941-0798
Practice Address - Fax:214-941-0408
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health