Organization
REVEL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK VAUGHAN LMFT (OWNER/THERAPIST)
(619) 952-8263
Entity
Organization
Contact information
Practice address
1740 RIDGE AVE STE 305, EVANSTON, IL 60201-5909
(312) 899-6184
Mailing address
2619 CENTRAL ST APT 3, EVANSTON, IL 60201-6415
(619) 952-8263
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
11/12/2018
Last updated
11/30/2020
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