# REVIVAL PSYCHIATRY AND KETAMINE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235847286
- **Authorized official:** ERIN JONES FNP/PMHNP (OWNER/PROVIDER)
- **Authorized official phone:** (480) 613-8162

## Contact information

- **Practice address:** 1220 S ALMA SCHOOL RD STE 212, MESA, AZ 85210-2087
- **Practice address phone:** (480) 613-8162
- **Practice address fax:** (480) 900-8654
- **Mailing address:** 1220 S ALMA SCHOOL RD STE 212, MESA, AZ 85210-2087
- **Mailing address phone:** (480) 613-8162
- **Mailing address fax:** (480) 900-8654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2022
- **Last updated:** 11/08/2022