REVIVE PSYCHIATRIC SERVICES, LLC (NPI# 1225504962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225504962 |
| Entity Type | Organization |
| Organization Name | REVIVE PSYCHIATRIC SERVICES, LLC |
| Practice Address |
302 Cedar Lake Dr Youngsville LA 70592-6574 |
| Mailing Address |
Po Box 530 Youngsville LA 70592-0530 |
| Practice Telephone | 3372472533 |
| Enumeration Date | 2018-10-21 |
| Last Update Date | 2018-10-21 |
| Authorized Official Name | SETH BOWERS (OWNER) |
| Authorized Official Telephone | 3372472533 |
| Authorized Official Credential | PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
302 CEDAR LAKE DR |
| City | YOUNGSVILLE |
| State | LA |
| Zip Code | 70592-6574 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437796844 | Tanisha Daniele Middleton | Behavior Technician | 209 Centre Scarcelle Boulevard, 201, Youngsville, LA 70592 | 2019-12-04 |
| 1578023800 | Youngsville Eye Clinic LLC | Optometrist | 2818 Bonin Rd, Youngsville, LA 70592 | 2019-03-22 |
| 1942727763 | Katherine Broussard Juneau | Social Worker | 317 Nora Broussard Rd, Youngsville, LA 70592 | 2017-08-23 |
| 1538694773 | Luciana Girouard | Behavior Technician | 209 Centre Sarcelle Blvd Ste 201, Youngsville, LA 70592 | 2017-04-25 |
| 1922557750 | Whispering Oaks Lodge LLC | Substance Abuse Rehabilitation Facility | 617 Piat Road, Youngsville, LA 70592 | 2016-09-21 |
| 1811362528 | Lauren Stone | Physical Therapist | 100 Holstien Ln, Youngsville, LA 70592 | 2015-12-07 |
| 1356671374 | Louisiana Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 2910 E. Milton Ave, Youngsville, LA 70592 | 2010-01-14 |
| 1376778464 | Anne Marie Biro | Physical Therapy Assistant | 170 Atlas Road, Youngsville, LA 70592 | 2009-05-19 |
| 1457593618 | Fallon Strother Mcmanus | Family Medicine | 103 Centre Sarcelle Blvd, Suite 506, Youngsville, LA 70592 | 2009-04-01 |
| 1346497146 | Cashway Pharmacy of Youngsville | Pharmacist | 810 S. Saint Blaise Lane, Suite A, Youngsville, LA 70592 | 2008-08-22 |
| Find all providers in zip 70592 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972113124 | Rebirth Mental Health Services LLC | Nurse Practitioner | 2116 Gause Blvd W Ste E, Slidell, LA 70460-4120 | 2020-08-03 |
| 1427668748 | Julie Susann Dyrek | Nurse Practitioner | 1 Lakeshore Dr Ste 1830, Lake Charles, LA 70629-0114 | 2020-08-01 |
| 1376169979 | Nancy Ariwodo | Nurse Practitioner | 225 Rue La France, Lafayette, LA 70508-1565 | 2020-06-19 |
| 1578183208 | Donald Glyn Gardner II | Nurse Practitioner | 324 Blue Fox Cir, Haughton, LA 71037-7707 | 2020-04-22 |
| 1629604129 | Raelyn Marie Plauche | Nurse Practitioner | 1951 Florida Ave Sw Ste D&e, Denham Springs, LA 70726-4947 | 2020-03-16 |
| 1962035964 | Tyler Trenton Wansley | Nurse Practitioner | 23515 Us-190, Mandeville, LA 70448 | 2020-02-18 |
| 1114558715 | Danielle J Threatts Aprn LLC | Nurse Practitioner | 208 W Gloria Switch Rd Ste 219, Lafayette, LA 70507-3409 | 2020-02-01 |
| 1992359848 | Harold G Frizzell Psychiatric Services LLC | Nurse Practitioner | 300 Thompson Loop, Lafayette, LA 70506-2820 | 2019-07-29 |
| 1598227779 | Candyce Brown | Nurse Practitioner | 333 Dr Michael Debakey Dr Ste 220, Lake Charles, LA 70601-5888 | 2019-04-04 |
| 1659835346 | Cassandra Thomas-jingles Psychiatric Nurse Practitioner, LLC. | Nurse Practitioner | 156 Mcgehee Dr, Baton Rouge, LA 70815-5012 | 2019-01-26 |
| Find all providers with the same taxonomy | ||||
| City | YOUNGSVILLE |
| Zip Code | 70592 |
Please comment or provide details below to improve the information on REVIVE PSYCHIATRIC SERVICES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.