Organization
REVIVAL COLLABORATIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH S HEDGES LPC (OWNER)
(479) 721-2110
Entity
Organization
Contact information
Practice address
3700 MEDICAL CENTER PKWY, BENTONVILLE, AR 72712-3222
(479) 721-2110
Mailing address
3202 SW HAZELNUT AVE, BENTONVILLE, AR 72713-3195
(479) 721-2110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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