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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