Provider Demographics
NPI:1346065349
Name:REVEALING LIFE HOLISTIC SERVICES, LLC
Entity type:Organization
Organization Name:REVEALING LIFE HOLISTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MAREN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:507-363-9365
Mailing Address - Street 1:1675 VILLAGE TRL E UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5820
Mailing Address - Country:US
Mailing Address - Phone:507-363-9365
Mailing Address - Fax:
Practice Address - Street 1:1935 COUNTY ROAD B2 W STE 245
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2722
Practice Address - Country:US
Practice Address - Phone:507-363-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty