Provider Demographics
NPI:1972047033
Name:HARPER, RAVEN DANIELLE
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:DANIELLE
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 PRIDGEON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5971
Mailing Address - Country:US
Mailing Address - Phone:318-805-4491
Mailing Address - Fax:
Practice Address - Street 1:9414 PRIDGEON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5971
Practice Address - Country:US
Practice Address - Phone:318-805-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health