# REVIVE BEHAVIORAL HEALTH AND WELLNESS LLC

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

## Provider details

- **NPI number:** 1548926801
- **Authorized official:** ANGELA LYON LICSW (OWNER)
- **Authorized official phone:** (308) 850-4330

## Contact information

- **Practice address:** 215 N WHEELER AVE, GRAND ISLAND, NE 68801-5961
- **Practice address phone:** (308) 391-2280
- **Practice address fax:** (308) 832-4803
- **Mailing address:** 215 N WHEELER AVE, GRAND ISLAND, NE 68801-5961
- **Mailing address phone:** (308) 391-2280
- **Mailing address fax:** (308) 832-4803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 11/11/2021
- **Last updated:** 09/14/2022