Provider Demographics
NPI:1184257503
Name:REVI, KAILEY MARGARET (LPC, NCC, MS)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:MARGARET
Last Name:REVI
Suffix:
Gender:F
Credentials:LPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 S SAINT CLAIR ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3660
Mailing Address - Country:US
Mailing Address - Phone:724-579-4508
Mailing Address - Fax:
Practice Address - Street 1:101 N MEADOWS DR # 234
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8368
Practice Address - Country:US
Practice Address - Phone:412-380-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC012180OtherLICENSE