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General NPI Number Information
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NPI Number | 1386218980
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Entity Type | Organization
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Legal Business Name | REVIVE WELLNESS FAMILY COUNSELING
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 180 E 35TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90011-2315
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Country | US
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Telephone | 323-449-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 2726 BRIGHTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90018-3117
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Country | US
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Telephone | 213-422-5393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. WENDY NUNO
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Credential | LMFT
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Telephone | 323-449-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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