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Organization
REVIVE BEHAVIORAL THERAPY LLC
Active
Organization
REVIVE BEHAVIORAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN DOUGLAS KENT M.A. (BCBA)
(857) 500-3381
Entity
Organization
Contact information
Practice address
4715 CHARLES PARTIN DR, PARRISH, FL 34219-1243
(857) 500-3381
Mailing address
4715 CHARLES PARTIN DR, PARRISH, FL 34219-1243
(857) 500-3381
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
11/27/2024
Last updated
11/27/2024
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