Organization
REVIVE PSYCHIATRIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SETH JORDAN BOWERS PMHNP-BC (OWNER/PROVIDER)
(337) 247-2533
Entity
Organization
Contact information
Practice address
221 RUE DE JEAN STE 210, LAFAYETTE, LA 70508-3283
(337) 450-9452
(337) 222-3934
Mailing address
PO BOX 530, YOUNGSVILLE, LA 70592-0530
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/21/2018
Last updated
10/31/2024
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