| Revitalizing Lifestyle Medicine Llc | |
|
111 E Monument Ave Unit 324 Kissimmee FL 34741-5771 | |
| (321) 442-0192 | |
| (321) 319-9730 |
| Full Name | Revitalizing Lifestyle Medicine Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 111 E Monument Ave Unit 324, Kissimmee, Florida |
| Authorized Official Name and Position | Michael Mcgowan (OWNER) |
| Authorized Official Contact | 3214420192 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalizing Lifestyle Medicine Llc 111 E Monument Ave Unit 324 Kissimmee FL 34741-5771 Ph: (321) 442-0192 | Revitalizing Lifestyle Medicine Llc 111 E Monument Ave Unit 324 Kissimmee FL 34741-5771 Ph: (321) 442-0192 |
| NPI Number | 1598542763 |
|---|---|
| Provider Enumeration Date | 09/12/2023 |
| Last Update Date | 11/13/2023 |
| Certification Date | 11/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598542763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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