Provider Demographics
NPI:1689489635
Name:RAVEN HALL LLC
Entity type:Organization
Organization Name:RAVEN HALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:435-491-0132
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:TEASDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84773-0132
Mailing Address - Country:US
Mailing Address - Phone:435-491-0132
Mailing Address - Fax:
Practice Address - Street 1:28 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TEASDALE
Practice Address - State:UT
Practice Address - Zip Code:84773-7722
Practice Address - Country:US
Practice Address - Phone:435-491-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty