Provider Demographics
NPI:1760233860
Name:REVISE WELLNESS SERVICES
Entity Type:Organization
Organization Name:REVISE WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CIDDET
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABRAHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP RN PMHNP-BC
Authorized Official - Phone:210-953-8566
Mailing Address - Street 1:17806 IH 10 W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8222
Mailing Address - Country:US
Mailing Address - Phone:210-953-8566
Mailing Address - Fax:830-264-8021
Practice Address - Street 1:17806 IH 10 W STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-8222
Practice Address - Country:US
Practice Address - Phone:210-953-8566
Practice Address - Fax:830-264-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty