Organization · Type 2 NPI

Life Revival LLC

Community/Behavioral Health Agency · Philadelphia, PA

NPI number 1023701067 Active

Practice location

6404 Roosevelt Blvd
Philadelphia, PA 19149-2943

Specialties and licenses

Taxonomy	Code	License
Mental Health Counselor	101YM0800X	None listed
Counseling Psychologist	103TC1900X	None listed
Family Psychologist	103TF0000X	None listed
Psychoanalysis Psychologist	103TP0814X	None listed
Group Psychotherapy Psychologist	103TP2701X	None listed
Clinical Social Worker	1041C0700X	None listed
Psychiatry Physician	2084P0800X	None listed
Child & Adolescent Psychiatry Physician	2084P0804X	None listed
Geriatric Psychiatry Physician	2084P0805X	None listed
Case Management Agency	251B00000X	None listed
Community/Behavioral Health Agency Primary	251S00000X	None listed
Mental Health Clinic/Center (Including Community Mental Health Center)	261QM0801X	None listed
Adult Mental Health Clinic/Center	261QM0850X	None listed
Adolescent and Children Mental Health Clinic/Center	261QM0855X	None listed
Psychiatric/Mental Health Nurse Practitioner	363LP0808X	None listed

Community/Behavioral Health Agency: A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day suppo…

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About NPI 1023701067

Life Revival LLC's National Provider Identifier is 1023701067, issued on May 26, 2023. The primary taxonomy on file is Community/Behavioral Health Agency (251S00000X), and the practice location is in Philadelphia, PA. The record was last updated on Feb 11, 2025.