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General NPI Number Information
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NPI Number | 1053195263
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Entity Type | Organization
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Legal Business Name | REVITALIZE COUNSELING & CONSULTATION SERVICES
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 610 ISAAC HAYES DR.
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 901-569-2823
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Fax |
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Provider Business Mailing Address
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Address Line | 610 ISAAC HAYES DR
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City | DYERSBURG
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State | TN
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Zip | 38024-3668
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Country | US
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Telephone | 901-569-2823
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN FOSTER MURPHY
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Credential | LPC
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Telephone | 901-569-2823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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