NPIMap

Organization Active NPI

Raven Counseling and Wellness LLC

  • Mental Health Counselor
  • Albuquerque, NM
National Provider Identifier
1780911347
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0100131 Issued in NM
Legal business name
RAVEN COUNSELING AND WELLNESS LLC
Doing business as
Raven Counseling and Wellness LLC
Practice address
8625 Golf Course Rd NW Ste B2
Albuquerque, NM 87114-5114
Phone
(505) 508-0808
Fax
(888) 896-8728
NPI assigned
Nov 3, 2009
Last updated
Dec 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Authorized official

Name
Tanya Medina, CPB-COC
Title
Billing & Network
Phone
(505) 508-0808

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 0100131 NM Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

8625 Golf Course Rd NW Ste B2
Albuquerque, NM 87114-5114

Mailing address

8625 Golf Course Rd NW Ste B2
Albuquerque, NM 87114-5114
Phone (505) 508-0808

Other names 1

  • Raven Counseling and Wellness LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160219001302 NM Part B Supplier - Clinic/Group Practice 3072818616 Receives reassigned benefits from 3 practitioners
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory

Locations

10511 Golf Course Rd NW
Ste 102
Albuquerque, NM 87114
Phone (505) 508-0808

4601 Paradise Blvd NW
Ste G
Albuquerque, NM 87114
Phone (505) 508-0808

8625 Golf Course Rd NW
Ste 2
Albuquerque, NM 87114

8625 Golf Course Rd NW
Ste B2
Albuquerque, NM 87114
Phone (505) 508-0808

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765238400000",
    "number": "1780911347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8625 GOLF COURSE RD NW STE B2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145114",
            "telephone_number": "505-508-0808",
            "fax_number": "888-896-8728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8625 GOLF COURSE RD NW STE B2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145114",
            "telephone_number": "505-508-0808",
            "fax_number": "888-896-8728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVEN COUNSELING AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "BILLING & NETWORK",
        "authorized_official_telephone_number": "505-508-0808",
        "authorized_official_credential": "CPB-COC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "0100131",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raven Counseling and Wellness LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.