Provider Demographics
NPI:1770126310
Name:REVELS, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:REVELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 FISHCREEK RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5404
Mailing Address - Country:US
Mailing Address - Phone:330-606-9262
Mailing Address - Fax:
Practice Address - Street 1:580 GRANT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-9910
Practice Address - Country:US
Practice Address - Phone:330-376-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902023-TRNE101YM0800X
OHE.2203123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health