| Revive Counseling Llc | |
|
9666 Olive Blvd Ste 510 Saint Louis MO 63132-3026 | |
| (314) 365-6421 | |
| Not Available |
| Full Name | Revive Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 9666 Olive Blvd Ste 510, Saint Louis, Missouri |
| Authorized Official Name and Position | Samantha Buettner (OWNER) |
| Authorized Official Contact | 3143656421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Counseling Llc 5830 Lookout Vw Cedar Hill MO 63016-1916 Ph: (314) 365-6421 | Revive Counseling Llc 9666 Olive Blvd Ste 510 Saint Louis MO 63132-3026 Ph: (314) 365-6421 |
| NPI Number | 1073347605 |
|---|---|
| Provider Enumeration Date | 08/27/2024 |
| Last Update Date | 12/23/2024 |
| Certification Date | 12/23/2024 |
| Medicare PECOS PAC ID | 9436681863 |
|---|---|
| Medicare Enrollment ID | O20241010001055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073347605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Samantha Buettner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366912388 PECOS PAC ID: 8325496706 Enrollment ID: I20231122003262 |
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