Healthcare Provider Details

I. General information

NPI: 1508734211
Provider Name (Legal Business Name): REVLIN THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2771 LIMESTONE DR
THOUSAND OAKS CA
91362-5788
US

IV. Provider business mailing address

2771 LIMESTONE DR
THOUSAND OAKS CA
91362-5788
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-8717
  • Fax:
Mailing address:
  • Phone: 310-666-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. SCOTT REVLIN
Title or Position: OWNER
Credential: MA, BCBA
Phone: 310-666-8717