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1760323265 NPI number — THE REVIVAL ROOM, LLC

NPI Number: 1760323265
Health Care Provider/Practitioner: THE REVIVAL ROOM, LLC

Information about “1760323265” NPI (THE REVIVAL ROOM, LLC) exists in 1760323265 in HTML format HTML  |  1760323265 in plain Text format TXT  |  1760323265 in PDF (Portable Document Format) PDF  |  1760323265 in an XML format XML  formats.

NPI Number : 1760323265 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760323265",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE REVIVAL ROOM, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "301 N SPRING ST STE 130",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELLEFONTE",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "16823-1543",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "814-343-1533",
    "MailingAddressFaxNumber": "888-253-1993",
    "FirstLinePracticeLocationAddress": "301 N SPRING ST STE 130",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELLEFONTE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "16823-1543",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "814-343-1533",
    "PracticeLocationAddressFaxNumber": "888-253-1993",
    "EnumerationDate": "04/01/2026",
    "LastUpdateDate": "04/01/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JABCO",
    "AuthorizedOfficialFirstName": "JAYCIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LPC",
    "AuthorizedOfficialTelephoneNumber": "717-487-8857",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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