Provider Information for 1477989713
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RAVEN T. O'ROURKE KEOHAN LCSW
Other Names:Professional Name:RAVEN TAYLOR O'ROURKE LCSWSex: Female
NPI: 1477989713
Last Updated: 2024-03-08
Certification Date: 2024-03-06
Certification Date: 2024-03-06
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1477989713 | ||||||||||||
| Enumeration Date | 2013-09-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 401 SOUTH MOUNT JULIET ROAD SUITE 235 #170 MT. JULIET, TN 37122-3616 United States Phone: 615-285-9134 | Fax: | ||||||||||||
| Primary Practice Address | 719 THOMPSON LANE SUITE 37189 NASHVILLE, TN 37204 United States Phone: 615-285-9134 | Fax: | ||||||||||||
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