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Organization
RAVEN COUNSELING AND WELLNESS LLC
Active
Organization
RAVEN COUNSELING AND WELLNESS LLC
Active
Other names
Raven Counseling and Wellness LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA MEDINA CPB-COC (BILLING & NETWORK)
(505) 508-0808
Entity
Organization
Contact information
Practice address
8625 GOLF COURSE RD NW STE B2, ALBUQUERQUE, NM 87114-5114
(505) 508-0808
(888) 896-8728
Mailing address
8625 GOLF COURSE RD NW STE B2, ALBUQUERQUE, NM 87114-5114
(505) 508-0808
(888) 896-8728
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
0100131
NM
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003165431
OPTUMBEHAVIORALHEALTH
NM
01
—
00NM00TQ09
BCBSNETWORKGROUPPRACTICE
NM
05
—
58973303
—
NM
01
—
600670197
MAGELLANHEALTHCARE
NM
01
—
GL000004020499
UHCADVANTAGEPLANS
NM
Enumeration date
11/03/2009
Last updated
12/09/2025
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