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General NPI Number Information
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NPI Number | 1225753858
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Entity Type | Organization
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Legal Business Name | REVIVE THERAPY SERVICES
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 4305 LOCUST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5382
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Country | US
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Telephone | 267-600-8142
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 KINGSESSING AVE FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19143-3712
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Country | US
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Telephone | 267-600-8142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANNAH GUY
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Credential | LCSW
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Telephone | 267-600-8142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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