Organization
REVIVAL PSYCHIATRY AND KETAMINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN JONES FNP/PMHNP (OWNER/PROVIDER)
(480) 613-8162
Entity
Organization
Contact information
Practice address
1220 S ALMA SCHOOL RD STE 212, MESA, AZ 85210-2087
(480) 613-8162
(480) 900-8654
Mailing address
1220 S ALMA SCHOOL RD STE 212, MESA, AZ 85210-2087
(480) 613-8162
(480) 900-8654
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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