Provider Demographics
NPI:1295470102
Name:REVIVE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:REVIVE COUNSELING SERVICES LLC
Other - Org Name:REVIVE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:978-242-7901
Mailing Address - Street 1:225 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-2222
Mailing Address - Country:US
Mailing Address - Phone:978-818-3965
Mailing Address - Fax:
Practice Address - Street 1:435 NEWBURY ST STE 222
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1065
Practice Address - Country:US
Practice Address - Phone:978-242-7901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)