Provider Demographics
NPI:1891556288
Name:REVIVE COUNSELING & WELLNESS, LLC
Entity Type:Organization
Organization Name:REVIVE COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:502-632-3282
Mailing Address - Street 1:308 EVERGREEN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1076
Mailing Address - Country:US
Mailing Address - Phone:502-632-3282
Mailing Address - Fax:
Practice Address - Street 1:308 EVERGREEN RD STE 140
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1076
Practice Address - Country:US
Practice Address - Phone:502-632-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty