Organization Active NPI

Revitalize Counseling Services LLC

  • Professional Counselor
  • Menasha, WI
National Provider Identifier
1073401295
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
REVITALIZE COUNSELING SERVICES LLC
Practice address
1486 Kenwood Dr Ste 101
Menasha, WI 54952-1133
Phone
(920) 284-7950
NPI assigned
Jun 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Katherine Jo SaintNPI 1467726976
Title
Owner
Phone
(920) 284-7950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X

Addresses

Primary practice location

1486 Kenwood Dr Ste 101
Menasha, WI 54952-1133

Mailing address

1486 Kenwood Dr Ste 101
Menasha, WI 54952-1133
Phone (920) 284-7950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250709000090 WI Part B Supplier - Clinic/Group Practice 7315451754 Receives reassigned benefits from 1 practitioner
Practice locations: Menasha, WI

National Provider Directory

National Provider Directory

Locations

1486 Kenwood Dr
Ste 101
Menasha, WI 54952
Phone (608) 343-7321

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1073401295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1486 KENWOOD DR STE 101",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521133",
            "telephone_number": "920-284-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1486 KENWOOD DR STE 101",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521133",
            "telephone_number": "920-284-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-26",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "SAINT",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-284-7950"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.