Organization
CENTRO DE MI SALUD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHEAL CHRISTOPHER RAVEN BSW (QMHP)
(214) 941-0798
Entity
Organization
Contact information
Practice address
628 CENTRE ST, DALLAS, TX 75208-6328
(214) 941-0798
(214) 941-0408
Mailing address
13043 GEORGE FOSTER RD, PONDER, TX 76259-4009
(214) 941-0798
(214) 941-0408
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043204019
—
TX
Enumeration date
11/14/2008
Last updated
11/14/2008
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