Provider Demographics
NPI:1689498412
Name:REVIVE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:REVIVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KARRLE
Authorized Official - Suffix:
Authorized Official - Credentials:CSWA
Authorized Official - Phone:541-205-9226
Mailing Address - Street 1:3704 LA MARADA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7632
Mailing Address - Country:US
Mailing Address - Phone:541-205-9226
Mailing Address - Fax:
Practice Address - Street 1:3704 LA MARADA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7632
Practice Address - Country:US
Practice Address - Phone:541-205-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty