Provider Demographics
NPI:1356060701
Name:RAVEN HOLISTIC HEALTH LLC
Entity type:Organization
Organization Name:RAVEN HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-245-7640
Mailing Address - Street 1:5289 GREENE 628 RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-8025
Mailing Address - Country:US
Mailing Address - Phone:870-245-7640
Mailing Address - Fax:
Practice Address - Street 1:5289 GREENE 628 RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-8025
Practice Address - Country:US
Practice Address - Phone:870-245-7640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)