Provider Demographics
NPI:1215795471
Name:REVIVE THERAPY AND COUNSELING SERVICES
Entity type:Organization
Organization Name:REVIVE THERAPY AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KLEINHANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:186-581-6430
Mailing Address - Street 1:3032 SAGEGRASS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3572
Mailing Address - Country:US
Mailing Address - Phone:186-581-6430
Mailing Address - Fax:
Practice Address - Street 1:3032 SAGEGRASS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-3572
Practice Address - Country:US
Practice Address - Phone:186-581-6430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)