Provider Demographics
NPI:1396392924
Name:PEACEFUL REVOLUTION LLC
Entity Type:Organization
Organization Name:PEACEFUL REVOLUTION LLC
Other - Org Name:OWN YOUR COLORS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST AND BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BURTENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-764-7767
Mailing Address - Street 1:4414 CENTERVIEW STE 273
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1405
Mailing Address - Country:US
Mailing Address - Phone:210-764-7767
Mailing Address - Fax:210-764-7767
Practice Address - Street 1:4414 CENTERVIEW STE 273
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1405
Practice Address - Country:US
Practice Address - Phone:210-764-7767
Practice Address - Fax:210-764-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty