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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
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
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
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
490084654 05 MO
institution
Provider Business Practice Location Address Details
Address
10071 Crescent Rd
City
Potosi
State
Missouri
Zip
63664-2040
Phone Number
573-438-9800
Fax Number
573-240-9916
person
Provider Business Mailing Address Details
Address
10071 Crescent Rd
City
Potosi
State
Missouri
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
101YP2500X
License No.
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Definition
Definition to come...
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