institution
Revive 180 Llc
Professional Counselor in Potosi, Missouri
NPI 1568197556

Revive 180 Llc is a Professional Counselor based in Potosi, MO and is specialized in Professional. Revive 180 Llc practices in Potosi, MO. The NPI Number for Revive 180 Llc is 1568197556 and holds a License No. (Missouri).

The current practice location address for Revive 180 Llc is 10071 Crescent Rd, Potosi, MO and can be reached out via phone at 573-438-9800 and via fax at 573-240-9916.

Location: 10071 Crescent Rd, Potosi, MO, 63664-2040
institution
Provider Profile Details
NPI Number
1568197556
Provider Name
Revive 180 Llc
Credential
Provider Entity Type
Organization
Address
10071 Crescent Rd, Potosi, MO, 63664-2040
Phone Number
573-438-9800
Fax Number
573-240-9916
Provider Enumeration Date
07/22/2022
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
490084654 05 MO
institution
Provider Business Practice Location Address Details
Address
10071 Crescent Rd
City
State
Zip
63664-2040
Phone Number
573-438-9800
Fax Number
573-240-9916
person
Provider Business Mailing Address Details
Address
10071 Crescent Rd
City
State
Zip
63664-2040
Phone Number
573-438-9800
Fax Number
573-240-9916
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
()
Definition
Definition to come...
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