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General NPI Number Information
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NPI Number | 1790335057
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Entity Type | Organization
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Legal Business Name | REVIVE COUNSELING
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 7808 E 108TH ST
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City | TULSA
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State | OK
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Zip | 74133-7415
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Country | US
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Telephone | 918-844-4148
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Fax | 539-999-8009
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Provider Business Mailing Address
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Address Line | 7808 E 108TH ST
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City | TULSA
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State | OK
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Zip | 74133-7415
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Country | US
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Telephone | 918-844-4148
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Fax | 539-999-8009
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Authorized Official
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Title or Position | OWNER
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Name | ABBY LOU SIMPSON
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Credential | MA, LPC
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Telephone | 918-693-9388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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