| Revival Therapy Services Llc | |
|
1133 N Pennsylvania St Denver CO 80203-2502 | |
| (303) 551-0117 | |
| (303) 551-0117 |
| Full Name | Revival Therapy Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 1133 N Pennsylvania St, Denver, Colorado |
| Authorized Official Name and Position | Sacha Lacasse (DIRECTOR) |
| Authorized Official Contact | 7204414622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revival Therapy Services Llc 1133 N Pennsylvania St Denver CO 80203-2502 Ph: (303) 551-0117 | Revival Therapy Services Llc 1133 N Pennsylvania St Denver CO 80203-2502 Ph: (303) 551-0117 |
| NPI Number | 1457008591 |
|---|---|
| Provider Enumeration Date | 03/08/2022 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 2668919119 |
|---|---|
| Medicare Enrollment ID | O20240802000064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457008591 | NPI | - | NPPES |
| Provider Name | Sacha Lacasse |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326504630 PECOS PAC ID: 9931431988 Enrollment ID: I20240802000111 |
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