Raven Royal

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

134483 Issued in CA

Practice address

129 E Center St Ste 3
Manteca, CA 95336-4648

Phone

(209) 239-5553

NPI assigned

Dec 13, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Mrs. Raven Royal Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Community Counseling Services, Inc

  • Community/Behavioral Health Agency
  • Manteca, CA
  • NPI 1811010267
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1134540362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7404 DELTAWIND DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958315201",
            "telephone_number": "916-218-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 E CENTER ST STE 3",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364648",
            "telephone_number": "209-239-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROYAL",
        "first_name": "RAVEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-13",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "109H00000X",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "109237",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "134483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAVEN",
            "last_name": "ROYAL",
            "prefix": "MRS.",
            "credential": "LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janice Sue Ross, RCP
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• Russell Bradley Rottacker, DC
• Maricel Ruffy
• Yesica Ruiz Ruiz, PHYSICAL THERAPY
• Russell P Carter Jr MD Inc
• Rally Respiandor Rutaquio
• Vienna Sa, MA, MT-BC, NMT

• Marriage & Family Therapist in Manteca, CA
• Providers in Manteca, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.