Provider Demographics
NPI:1528449287
Name:REVADA, JANUARY M (LPC)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:M
Last Name:REVADA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 LOUETTA RD
Mailing Address - Street 2:SUITE 352
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4405
Mailing Address - Country:US
Mailing Address - Phone:832-257-2433
Mailing Address - Fax:
Practice Address - Street 1:16770 IMPERIAL VALLEY DR STE 125-I
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-6057
Practice Address - Country:US
Practice Address - Phone:832-257-2433
Practice Address - Fax:832-442-5151
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional