Revive Counseling LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REVIVE COUNSELING LLC

Practice address

8052 Monticello Ave Unit 103
Skokie, IL 60076-3438

Phone

(773) 609-1758

NPI assigned

Aug 31, 2021

Organization subpart

No

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

Authorized official

Name

Guadalupe Maya-Veskovic, LCSWNPI 1669986915

Title

Founder

Phone

(773) 609-1758

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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

• Guadalupe Maya-Veskovic, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1669986915
  NPD Authorized official

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1255009783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4188 COVE LN APT C",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600253561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8052 MONTICELLO AVE UNIT 103",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763438",
            "telephone_number": "773-609-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "MAYA-VESKOVIC",
        "authorized_official_first_name": "GUADALUPE",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "773-609-1758",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELF-PAY, COMMERCIAL INSURANCE",
            "identifier": "1669986915",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmaya-veskovic@outlook.com",
            "affiliation": "N",
            "address_1": "8052 Monticello Ave Unit 103",
            "city": "Skokie",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600763438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Skokie, IL
• Providers in Skokie, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.