Provider Demographics
NPI:1255941811
Name:REVIVAL COUNSELING & RECOVERY LLC
Entity type:Organization
Organization Name:REVIVAL COUNSELING & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMAC
Authorized Official - Phone:785-979-9199
Mailing Address - Street 1:2601 ANDERSON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2809
Mailing Address - Country:US
Mailing Address - Phone:785-579-9199
Mailing Address - Fax:
Practice Address - Street 1:2601 ANDERSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2809
Practice Address - Country:US
Practice Address - Phone:785-579-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)