Provider Demographics
NPI:1679196588
Name:MENTAL HEALTH REVOLUTION PLLC
Entity Type:Organization
Organization Name:MENTAL HEALTH REVOLUTION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-220-8010
Mailing Address - Street 1:1590 S MILWAUKEE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3786
Mailing Address - Country:US
Mailing Address - Phone:847-220-8010
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE STE 301
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3786
Practice Address - Country:US
Practice Address - Phone:847-220-8010
Practice Address - Fax:847-220-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty