Organization
REVERIE MIND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WALLACE (CEO)
(480) 828-6575
Entity
Organization
Contact information
Practice address
4055 W CHANDLER BLVD STE 5, CHANDLER, AZ 85226-3700
(480) 590-0092
Mailing address
4055 W CHANDLER BLVD STE 5, CHANDLER, AZ 85226-3700
(480) 590-0092
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
08/07/2024
Last updated
08/07/2024
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