| Revive Wellness | |
|
116 W Robert St Ste 2b Crookston MN 56716-1709 | |
| (218) 289-7023 | |
| Not Available |
| Full Name | Revive Wellness |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 116 W Robert St Ste 2b, Crookston, Minnesota |
| Authorized Official Name and Position | Jessica Nichole Shockman (MENTAL HEALTH PROFESSIONAL) |
| Authorized Official Contact | 2182897023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Wellness 116 W Robert St Ste 2b Crookston MN 56716-1709 Ph: (218) 289-7023 | Revive Wellness 116 W Robert St Ste 2b Crookston MN 56716-1709 Ph: (218) 289-7023 |
| NPI Number | 1639885171 |
|---|---|
| Provider Enumeration Date | 01/27/2023 |
| Last Update Date | 01/27/2023 |
| Certification Date | 01/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639885171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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