Provider Demographics
NPI:1386185825
Name:RAVITHIS, CASSIE LYNN
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:RAVITHIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 50TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2201
Mailing Address - Country:US
Mailing Address - Phone:970-518-2655
Mailing Address - Fax:
Practice Address - Street 1:1304 50TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2201
Practice Address - Country:US
Practice Address - Phone:970-518-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health