| Revive Wellness & Co | |
|
5335 Nueces Ln Grand Prairie TX 75052-2667 | |
| (972) 802-4892 | |
| Not Available |
| Full Name | Revive Wellness & Co |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5335 Nueces Ln, Grand Prairie, Texas |
| Authorized Official Name and Position | Samitriya L Moore (FOUNDER) |
| Authorized Official Contact | 9728024892 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Wellness & Co 5335 Nueces Ln Grand Prairie TX 75052-2667 Ph: (972) 802-4892 | Revive Wellness & Co 5335 Nueces Ln Grand Prairie TX 75052-2667 Ph: (972) 802-4892 |
| NPI Number | 1194502070 |
|---|---|
| Provider Enumeration Date | 09/13/2023 |
| Last Update Date | 09/13/2023 |
| Certification Date | 09/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194502070 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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