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General NPI Number Information
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NPI Number | 1053265058
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Entity Type | Organization
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Legal Business Name | REVIVE AND THRIVE MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 3239 JEFFERSON AVE STE 1
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City | CINCINNATI
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State | OH
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Zip | 45220-2270
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Country | US
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Telephone | 513-400-4976
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Fax |
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Provider Business Mailing Address
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Address Line | 3239 JEFFERSON AVE STE 1
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City | CINCINNATI
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State | OH
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Zip | 45220-2270
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Country | US
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Telephone | 513-400-4976
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATOYA PHILLIPS
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Credential |
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Telephone | 513-400-4976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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