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General NPI Number Information
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NPI Number | 1740010958
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Entity Type | Organization
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Legal Business Name | REVOLUTION THERAPY LLC
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1239 BARONNE ST STE C
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City | NEW ORLEANS
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State | LA
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Zip | 70113-1203
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Country | US
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Telephone | 504-478-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 BURGUNDY ST
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City | NEW ORLEANS
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State | LA
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Zip | 70117-1440
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Country | US
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Telephone | 504-478-4830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA OHLER
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Credential | LMHC, LPC
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Telephone | 504-478-4830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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