Provider Demographics
NPI:1174881320
Name:RANEY, PHAETRA KAFUNYA (LCSW)
Entity type:Individual
Prefix:DR
First Name:PHAETRA
Middle Name:KAFUNYA
Last Name:RANEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PHAETRA
Other - Middle Name:KAFUNYA
Other - Last Name:RANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHAETRA RANEY
Mailing Address - Street 1:19901 SOUTHWEST FWY STE 141
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6538
Mailing Address - Country:US
Mailing Address - Phone:832-363-7877
Mailing Address - Fax:832-451-6294
Practice Address - Street 1:313 S 5TH ST STE 7
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2755
Practice Address - Country:US
Practice Address - Phone:281-665-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251801041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical