1407343759 NPI number — REVENIR COUNSELING AND WELLNESS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407343759 NPI number — REVENIR COUNSELING AND WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REVENIR COUNSELING AND WELLNESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407343759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4131 SPICEWOOD SPRINGS RD STE H2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-8659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-262-4577
Provider Business Mailing Address Fax Number:
855-765-7552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4131 SPICEWOOD SPRINGS RD STE H2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-262-4577
Provider Business Practice Location Address Fax Number:
855-765-7552
Provider Enumeration Date:
04/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PARNELL
Authorized Official First Name:
DIXON
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER/SOLE PRACTITIONER
Authorized Official Telephone Number:
901-262-4577

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  71606 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 71606 . This is a "TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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