Provider Demographics
NPI:1881485217
Name:REVARD, JOSEPH FRANKLIN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANKLIN
Last Name:REVARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 208TH ST SW APT 100
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7280
Mailing Address - Country:US
Mailing Address - Phone:206-769-6182
Mailing Address - Fax:
Practice Address - Street 1:2322 196TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7010
Practice Address - Country:US
Practice Address - Phone:425-984-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61521518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)