Healthcare Provider Details

I. General information

NPI: 1134050099
Provider Name (Legal Business Name): REVIVE MENTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 LEXINGTON AVE STE B
MANSFIELD OH
44907-2251
US

IV. Provider business mailing address

1115 LEXINGTON AVE STE B
MANSFIELD OH
44907-2251
US

V. Phone/Fax

Practice location:
  • Phone: 318-327-8815
  • Fax:
Mailing address:
  • Phone: 318-327-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HANNAH ROSE FINLEY
Title or Position: OWNER-NURSE PRACTITIONER
Credential: APRN, PMHNP-BC
Phone: 419-571-3980