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General NPI Number Information
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NPI Number | 1073035374
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Entity Type | Organization
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Legal Business Name | REVOLVE BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 07/09/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 7405 COOPER LN
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City | AUSTIN
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State | TX
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Zip | 78745-6307
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Country | US
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Telephone | 512-588-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 714 BERNSTEIN ST
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City | AUSTIN
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State | TX
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Zip | 78745-5528
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Country | US
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Telephone | 512-550-2376
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. RAYMOND COMBS
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Credential | LMSW
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Telephone | 512-588-2368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 60227
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License Number State | TX
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