MEDICARE: HUMAN REVOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	400314001529	DC

General Provider Information

NPI Number	:	1609224377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMAN REVOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1629 K ST NW
Second Line	:	SUITE 300
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1602
Country	:	US
Telephone Number	:	202-744-1393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 BUCHANAN ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4446
Country	:	US
Telephone Number	:	202-744-1393
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER / CLINICAL DIRECTOR
Name	:	TIFFANI BONITA BOYKIN
Credential	:	LPC
Telephone Number	:	202-744-1393

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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