Organization
REVAMP CREATIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI PETRA DAVISSON LPC (LICENSED PROFESSIONAL COUNSELOR)
(503) 929-7750
Entity
Organization
Contact information
Practice address
4037 NE TILLAMOOK ST, PORTLAND, OR 97212-5341
(503) 929-7750
Mailing address
63 NE THOMPSON ST, PORTLAND, OR 97212-3741
(503) 929-7750
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/29/2023
Last updated
03/10/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up