MEDICARE: REVEALED PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	104100000X	Social Worker
5	1041C0700X	Clinical Social Worker
6	133N00000X	Nutritionist
7	133NN1002X	Nutrition Education Nutritionist
8	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
9	133VN1501X	Sports Dietetics Nutrition Registered Dietitian
10	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1184310732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVEALED PLLC

Provider Business Mailing Address
First Line	:	2309 W LONG SHADOW TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-6084
Country	:	US
Telephone Number	:	907-590-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 W LONG SHADOW TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-6084
Country	:	US
Telephone Number	:	907-590-5015
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	DR. MELODIE SIMMONS
Credential	:	MS, LPC, CEDS-S
Telephone Number	:	907-590-5015

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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