Organization
REVIVE WELLNESS & CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMITRIYA L MOORE PMHNP (FOUNDER)
(972) 802-4892
Entity
Organization
Contact information
Practice address
5335 NUECES LN, GRAND PRAIRIE, TX 75052-2667
(972) 802-4892
Mailing address
5335 NUECES LN, GRAND PRAIRIE, TX 75052-2667
(972) 802-4892
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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