Provider Demographics
NPI:1699342832
Name:REVIVE HEALING & WELLNESS INSTITUTE, LLC.
Entity type:Organization
Organization Name:REVIVE HEALING & WELLNESS INSTITUTE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:509-985-8788
Mailing Address - Street 1:970 SIDNEY MARCUS BLVD NE UNIT 1412
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3160
Mailing Address - Country:US
Mailing Address - Phone:404-500-9494
Mailing Address - Fax:
Practice Address - Street 1:970 SIDNEY MARCUS BLVD NE UNIT 1412
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3160
Practice Address - Country:US
Practice Address - Phone:404-500-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty