# REVISION PSYCHOTHERAPY LLC

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

## Provider details

- **NPI number:** 1770353625
- **Authorized official:** LAURELIN PRINELL STERNS LIMHP (INDEPENDENT MENTAL HEALTH COUNSELOR)
- **Authorized official phone:** (402) 312-0919

## Contact information

- **Practice address:** 1055 N 115TH ST STE 105, OMAHA, NE 68154-4419
- **Practice address phone:** (402) 312-0919
- **Mailing address:** 16655 DORA HAMANN PKWY, OMAHA, NE 68116-2303
- **Mailing address phone:** (402) 312-0919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 01/02/2024
- **Last updated:** 01/02/2024