Vicki L Revell-Smith, MS,LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

723 Issued in MS

Practice address

1600 Broad Ave
Gulfport, MS 39501-3603

Phone

(228) 863-1132

Fax

(228) 865-1700

NPI assigned

Jul 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 11, 2024 through Mar 11, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mind Works Therapy PLLC

  • Psychologist
  • Pass Christian, MS
  • NPI 1629601927
  NPD (past)

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194742296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013603",
            "telephone_number": "228-863-1132",
            "fax_number": "228-865-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013603",
            "telephone_number": "228-863-1132",
            "fax_number": "228-865-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELL-SMITH",
        "first_name": "VICKI",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "MS,LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018213",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Resonance Laboratories LLC
• Resonance Professional Counseling
• Melody Restivo, PT
• Restoration Counseling Services, LLC
• Restore Oculoplastics Gulf Coast
• Robert Revell, CPSS
• Mary Reynolds, IDD WAIVER SERVICES
• Gunner Rhoden, DMD
• Nicole Desiree Ribet, MT-BC
• Justine Rice

• Mental Health Counselor in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.