Organization
LIFE REVIVAL LLC
Active
Organization
LIFE REVIVAL LLC
Active
Other names
Life Revival, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL LEE PSYD (DIRECTOR)
(267) 259-4558
Entity
Organization
Contact information
Practice address
6404 ROOSEVELT BLVD, PHILADELPHIA, PA 19149-2943
(267) 577-7747
Mailing address
6404 ROOSEVELT BLVD, PHILADELPHIA, PA 19149-2943
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/26/2023
Last updated
02/11/2025
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