Provider Demographics
NPI:1386218980
Name:REVIVE WELLNESS FAMILY COUNSELING
Entity Type:Organization
Organization Name:REVIVE WELLNESS FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-449-4040
Mailing Address - Street 1:2726 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3117
Mailing Address - Country:US
Mailing Address - Phone:213-422-5393
Mailing Address - Fax:
Practice Address - Street 1:180 E 35TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-2315
Practice Address - Country:US
Practice Address - Phone:323-449-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty