Healthcare Provider Details

I. General information

NPI: 1790335057
Provider Name (Legal Business Name): REVIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 E 108TH ST
TULSA OK
74133-7415
US

IV. Provider business mailing address

7808 E 108TH ST
TULSA OK
74133-7415
US

V. Phone/Fax

Practice location:
  • Phone: 918-844-4148
  • Fax: 539-999-8009
Mailing address:
  • Phone: 918-844-4148
  • Fax: 539-999-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ABBY LOU SIMPSON
Title or Position: OWNER
Credential: MA, LPC
Phone: 918-693-9388