Provider Demographics
NPI:1295550168
Name:SOWELL, RAVEN (LBSW)
Entity type:Individual
Prefix:MS
First Name:RAVEN
Middle Name:
Last Name:SOWELL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-8020
Mailing Address - Country:US
Mailing Address - Phone:512-790-8432
Mailing Address - Fax:
Practice Address - Street 1:3055 STILLHOUSE LAKE RD STE 206
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8861
Practice Address - Country:US
Practice Address - Phone:254-813-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health