Provider Demographics
NPI:1619704681
Name:RAVEN, DEIRDRE
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:RAVEN
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 1:15500 VOSS RD STE 200-1067
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4601
Mailing Address - Country:US
Mailing Address - Phone:830-590-0909
Mailing Address - Fax:713-575-3889
Practice Address - Street 1:15500 VOSS RD STE 200-1067
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4601
Practice Address - Country:US
Practice Address - Phone:830-590-0909
Practice Address - Fax:713-575-3889
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717525163WA0400X, 163WA2000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WP0807X, 174H00000X, 405300000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No174H00000XOther Service ProvidersHealth Educator
No405300000XOther Service ProvidersPrevention Professional