Healthcare Provider Details

I. General information

NPI: 1003744038
Provider Name (Legal Business Name): REVAY STEWART LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 4TH AVE W
GRINNELL IA
50112-1895
US

IV. Provider business mailing address

217 4TH AVE W
GRINNELL IA
50112-1895
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-0632
  • Fax: 888-890-2713
Mailing address:
  • Phone: 641-236-0632
  • Fax: 888-890-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133574
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: