Deric V Ravsten (NPI# 1154431542, PAC ID# 4688636129) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PSYCHIATRY.
| Nation Provider ID (NPI) | 1154431542 |
| PAC ID by PECOS | 4688636129 |
| Professional Enrollment ID | I20041027001257 |
| Full Name | Deric V Ravsten |
| Organization Legal Name | LIFE CHANGE ASSOCIATES PC |
| Address |
2520 S 5th Ave Pocatello ID 83204-1923 |
| Phone Number | 2082335433 |
| Gender | M |
| Credential | DO |
| Medical School | UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES |
| Graduation Year | 1995 |
| Primary Specialty | PSYCHIATRY |
| Group Practice PAC ID | 8224265574 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 131324 | LOST RIVERS MEDICAL CENTER |
| 130028 | PORTNEUF MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2520 S 5th Ave, Pocatello, ID 83204-1923 | 2082335433 | LIFE CHANGE ASSOCIATES PC |
| Organization Legal Name | LIFE CHANGE ASSOCIATES PC |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Karl M Letko | Physician Assistant | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Kebai D Bills | Physician Assistant | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Steven L Ater | Psychologist, Clinical | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Stephanie A Clark | Nurse Practitioner | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Jerilyn Pence | Clinical Social Worker | Life Change Associates PC | 1777 E Clark St, Pocatello, ID 83201-3357 |
| Street Address |
2520 S 5TH AVE |
| City | POCATELLO |
| State | ID |
| Zip | 83204-1923 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Karl M Letko | Physician Assistant | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Kebai D Bills | Physician Assistant | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Steven L Ater | Psychologist, Clinical | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Stephanie A Clark | Nurse Practitioner | Life Change Associates PC | 2520 S 5th Ave, Pocatello, ID 83204-1923 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael L Stevens | Clinical Social Worker | 109 N Arthur Ave, Suite 203, Pocatello, ID 83204-3105 | |
| Aaron L Schaerrer | Clinical Social Worker | Hope Tree Inc | 109 N Arthur Ave, Suite 203, Pocatello, ID 83204-3105 |
| Trent P Turner | Clinical Social Worker | Hope Tree Inc | 109 N Arthur Ave, Suite 203, Pocatello, ID 83204-3105 |
| Nancy Wheeler | Clinical Social Worker | Candlewood Family Counseling Center, Inc. | 335 N Main St, Pocatello, ID 83204-3108 |
| Angela K. Kelly | Clinical Social Worker | Candlewood Family Counseling Center, Inc. | 335 N Main St, Pocatello, ID 83204-3108 |
| Ella C Dingman | Clinical Social Worker | Candlewood Family Counseling Center, Inc. | 335 N Main St, Pocatello, ID 83204-3108 |
| Jill A Schuette | Occupational Therapy | Insight Occupational Therapy, LLC | 158 N Main St, Pocatello, ID 83204-3113 |
| Corey L Richardson | Clinical Social Worker | 224 S Arthur Ave, Suite 2, Pocatello, ID 83204-3202 | |
| Lacy D Hoffer | Clinical Social Worker | Gateway Counseling Incorporated | 224 S Arthur Ave, Suite 2, Pocatello, ID 83204-3202 |
| Michael R Flandro | Optometry | 360 S Arthur Ave, Pocatello, ID 83204-3307 | |
| Find all physicians in zip 83204 | |||
| City | POCATELLO |
| Zip Code | 83204 |
| Specialty | PSYCHIATRY |
| City + Specialty | POCATELLO + PSYCHIATRY |
Please comment or provide details below to improve the information on Deric V Ravsten.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.