Provider Demographics
NPI:1770353625
Name:REVISION PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:REVISION PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURELIN
Authorized Official - Middle Name:PRINELL
Authorized Official - Last Name:STERNS
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-312-0919
Mailing Address - Street 1:16655 DORA HAMANN PKWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2303
Mailing Address - Country:US
Mailing Address - Phone:402-312-0919
Mailing Address - Fax:
Practice Address - Street 1:1055 N 115TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4419
Practice Address - Country:US
Practice Address - Phone:402-312-0919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty