Provider Demographics
NPI:1205335783
Name:RAVEAU PSYCHOLOGY LLC
Entity type:Organization
Organization Name:RAVEAU PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASTI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-605-5402
Mailing Address - Street 1:19202 WINDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-3919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19202 WINDRIDGE DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-3919
Practice Address - Country:US
Practice Address - Phone:248-605-5402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health