Provider Demographics
NPI:1538817416
Name:REVIVE MENTAL HEALTH SOLUTIONS LLC
Entity type:Organization
Organization Name:REVIVE MENTAL HEALTH SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:STICE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:785-302-1090
Mailing Address - Street 1:670 J RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:KS
Mailing Address - Zip Code:67669-8821
Mailing Address - Country:US
Mailing Address - Phone:785-425-8374
Mailing Address - Fax:
Practice Address - Street 1:2810 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1924
Practice Address - Country:US
Practice Address - Phone:785-425-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty