Provider Demographics
NPI:1407343759
Name:REVENIR COUNSELING AND WELLNESS, PLLC
Entity type:Organization
Organization Name:REVENIR COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DIXON
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:901-262-4577
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD STE H2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8659
Mailing Address - Country:US
Mailing Address - Phone:901-262-4577
Mailing Address - Fax:855-765-7552
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE H2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:901-262-4577
Practice Address - Fax:855-765-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-21
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX71606OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS