Healthcare Provider Details

I. General information

NPI: 1144193517
Provider Name (Legal Business Name): REVIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 N 150TH ST
OMAHA NE
68116-4425
US

IV. Provider business mailing address

6609 N 150TH ST
OMAHA NE
68116-4425
US

V. Phone/Fax

Practice location:
  • Phone: 402-575-8400
  • Fax:
Mailing address:
  • Phone: 402-575-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN NGUYEN
Title or Position: MENTAL HEALTH COUNSELOR
Credential: PLMHP
Phone: 402-575-8400