Healthcare Provider Details

I. General information

NPI: 1770126310
Provider Name (Legal Business Name): DEANNA REVELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 GRANT ST
AKRON OH
44311-9910
US

IV. Provider business mailing address

3757 FISHCREEK RD
STOW OH
44224-5404
US

V. Phone/Fax

Practice location:
  • Phone: 330-376-9494
  • Fax:
Mailing address:
  • Phone: 330-606-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1902023-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2203123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: