Healthcare Provider Details

I. General information

NPI: 1215764550
Provider Name (Legal Business Name): REVELATIONS COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BROOKTREE RD STE 210
WEXFORD PA
15090-9272
US

IV. Provider business mailing address

6500 BROOKTREE RD STE 210
WEXFORD PA
15090-9272
US

V. Phone/Fax

Practice location:
  • Phone: 724-719-2669
  • Fax:
Mailing address:
  • Phone: 724-719-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ELISABETH PLUTKO
Title or Position: COO
Credential:
Phone: 724-719-2669