Individual
MR. NICHOLAS REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10151 SE SUNNYSIDE RD STE 480, HAPPY VALLEY, OR 97015-5705
(503) 739-8321
Mailing address
2854 TORTUGA VERDE, SAN ANTONIO, TX 78245-3705
(210) 862-8071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C10628
OR
101YP2500X
Professional Counselor
Primary
C10628
OR
Other
Enumeration date
06/13/2022
Last updated
04/02/2026
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