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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