MEDICARE: REVITALIZE COUNSELING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427948504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVITALIZE COUNSELING

Provider Business Mailing Address
First Line	:	10491 BEN C PRATT/6 MILE CYPRESS PKWY STE 250
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6514
Country	:	US
Telephone Number	:	239-896-6984
Fax Number	:

Provider Business Practice Location Address
First Line	:	10491 BEN C PRATT/6 MILE CYPRESS PKWY STE 250
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6514
Country	:	US
Telephone Number	:	239-896-6984
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CLINICIAN
Name	:	CHELSEA PIGEON
Credential	:	MA, LMHC
Telephone Number	:	239-896-6984

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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