| Raven Counseling And Wellness Llc | |
|
10511 Golf Course Rd Nw Ste 102 Albuquerque NM 87114-5917 | |
| (505) 508-0808 | |
| (888) 896-8728 |
| Full Name | Raven Counseling And Wellness Llc |
|---|---|
| Speciality | Counselor |
| Location | 10511 Golf Course Rd Nw Ste 102, Albuquerque, New Mexico |
| Authorized Official Name and Position | Julita G Pezzano (OWNER) |
| Authorized Official Contact | 5055080808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raven Counseling And Wellness Llc 10511 Golf Course Rd Nw Ste 102 Albuquerque NM 87114-5917 Ph: (505) 508-0808 | Raven Counseling And Wellness Llc 10511 Golf Course Rd Nw Ste 102 Albuquerque NM 87114-5917 Ph: (505) 508-0808 |
| NPI Number | 1780911347 |
|---|---|
| Provider Enumeration Date | 11/03/2009 |
| Last Update Date | 10/06/2017 |
| Medicare PECOS PAC ID | 3072818616 |
|---|---|
| Medicare Enrollment ID | O20160219001302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780911347 | NPI | - | NPPES |
| 05959519 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 0100131 (New Mexico) | Primary |
| Provider Name | Jacob P Torrez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942516547 PECOS PAC ID: 1052652856 Enrollment ID: I20190404000405 |
| Provider Name | Julita Gloria Pezzano |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720292782 PECOS PAC ID: 1153626791 Enrollment ID: I20240522004302 |
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