Provider Demographics
NPI:1922711563
Name:REVEL
Entity Type:Organization
Organization Name:REVEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:720-207-7166
Mailing Address - Street 1:3501 BLAKE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4889
Mailing Address - Country:US
Mailing Address - Phone:720-502-4927
Mailing Address - Fax:
Practice Address - Street 1:3501 BLAKE ST STE 250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4889
Practice Address - Country:US
Practice Address - Phone:720-502-4927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty