| Revitalize Minds Counseling | |
|
312 N Missouri St Ste 1 West Memphis AR 72301-3186 | |
| (870) 796-8997 | |
| (870) 796-8998 |
| Full Name | Revitalize Minds Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 312 N Missouri St Ste 1, West Memphis, Arkansas |
| Authorized Official Name and Position | Tangella Michelle Foreman (THERAPIST) |
| Authorized Official Contact | 8709267344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Minds Counseling 312 N Missouri St West Memphis AR 72301-3142 Ph: (870) 796-8997 | Revitalize Minds Counseling 312 N Missouri St Ste 1 West Memphis AR 72301-3186 Ph: (870) 796-8997 |
| NPI Number | 1467188664 |
|---|---|
| Provider Enumeration Date | 07/29/2022 |
| Last Update Date | 01/16/2023 |
| Certification Date | 08/05/2022 |
| Medicare PECOS PAC ID | 5294111290 |
|---|---|
| Medicare Enrollment ID | O20220928002057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467188664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tangella Foreman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609164730 PECOS PAC ID: 4789942939 Enrollment ID: I20171218002163 |
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