Organization
REVIVE BEHAVIOR HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIES POWELL (OWNER)
(702) 378-8840
Entity
Organization
Contact information
Practice address
2027 REVERE ST STE G, LAS VEGAS, NV 89106-2327
(702) 378-8840
Mailing address
322 FINCH RIDGE AVE, NORTH LAS VEGAS, NV 89032-9070
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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