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General NPI Number Information
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NPI Number | 1235894130
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Entity Type | Organization
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Legal Business Name | REVIVE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 801 N MAIN ST STE 2
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City | GARDEN CITY
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State | KS
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Zip | 67846-5436
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Country | US
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Telephone | 620-675-0040
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Fax | 844-645-1452
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Provider Business Mailing Address
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Address Line | PO BOX 1911
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City | GARDEN CITY
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State | KS
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Zip | 67846-1912
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Country | US
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Telephone | 620-675-0040
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Fax | 844-645-1452
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Authorized Official
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Title or Position | THERAPIST
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Name | MISTY HUMPHREY
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Credential | LCPC
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Telephone | 620-675-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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