Revival Collaborative LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

REVIVAL COLLABORATIVE LLC

Practice address

3700 Medical Center Pkwy
Bentonville, AR 72712-3222

Phone

(479) 721-2110

NPI assigned

Dec 15, 2021

Organization subpart

No

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

Authorized official

Name

Zach S Hedges, LPC

Title

Owner

Phone

(479) 721-2110

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Zachary S Hedges, LPC

  • Professional Counselor
  • Bentonville, AR
  • NPI 1356742464

  Mental Health

  NPD

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1407515620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3202 SW HAZELNUT AVE",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727133195",
            "telephone_number": "479-721-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 MEDICAL CENTER PKWY",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123222",
            "telephone_number": "479-721-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL COLLABORATIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "HEDGES",
        "authorized_official_first_name": "ZACH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-721-2110",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.