| Revive Wellco | |
|
518 Latham Ct. Clarksville TN 37043 | |
| (501) 318-3760 | |
| Not Available |
| Full Name | Revive Wellco |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 518 Latham Ct., Clarksville, Tennessee |
| Authorized Official Name and Position | Jennifer Schalow (CEO) |
| Authorized Official Contact | 5013183760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Wellco 919 Tiny Town Rd Suite B #2021 Clarksville TN 37042-7660 Ph: (501) 318-3760 | Revive Wellco 518 Latham Ct. Clarksville TN 37043 Ph: (501) 318-3760 |
| NPI Number | 1851070882 |
|---|---|
| Provider Enumeration Date | 07/17/2023 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851070882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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