Life Revive Counseling, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

LIFE REVIVE COUNSELING, LLC

Practice address

64501 232ND St
Glenwood, IA 51534-5008

Phone

(402) 660-7454

Fax

(712) 355-5234

NPI assigned

May 31, 2023

Last updated

May 31, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angela Marie Clark, PLMHPNPI 1275271256

Title

Counselor

Phone

(402) 660-7454

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Marie Clark, MA

  • Mental Health Counselor
  • Council Bluffs, IA
  • NPI 1275271256
  NPD Authorized official

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685491200000",
    "number": "1326731829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 N 29TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515010755",
            "telephone_number": "402-660-7454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64501 232ND ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515345008",
            "telephone_number": "402-660-7454",
            "fax_number": "712-355-5234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 N 29th St",
            "address_purpose": "LOCATION",
            "city": "Council Bluffs",
            "state": "IA",
            "postal_code": "515010755",
            "country_code": "US",
            "telephone_number": "402-660-7454",
            "fax_number": "712-355-5234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE REVIVE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "402-660-7454",
        "authorized_official_credential": "PLMHP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Lee Krueger, PHARMACIST
• Dara Latner, OD
• Katiejo Charmaine Lawton, OTR/L
• Sandra Elaine Leaders, F.N.P.
• Amanda Autumn Leick, PHARMD
• Robert Franklin Lothrop, DDS
• Julie L Lynes, MHR
• Margramon P C (Medicap Pharmacy)
• Johannah Marie McKibben, RN, BSN, FNP, MSN
• Amber Miller, R.PH.

• Adult Mental Health Clinic/Center in Glenwood, IA
• Providers in Glenwood, IA by specialty
• Adult Mental Health Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; 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.