Organization
LIFE REVIVE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA MARIE CLARK PLMHP (COUNSELOR)
(402) 660-7454
Entity
Organization
Contact information
Practice address
64501 232ND ST, GLENWOOD, IA 51534-5008
(402) 660-7454
(712) 355-5234
Mailing address
1001 N 29TH ST, COUNCIL BLUFFS, IA 51501-0755
(402) 660-7454
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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