NPIMap

Organization Active NPI

Revival Therapy Services LLC

  • Professional Counselor
  • Denver, CO
National Provider Identifier
1457008591
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
REVIVAL THERAPY SERVICES LLC
Practice address
1133 N Pennsylvania St
Denver, CO 80203-2502
Phone
(303) 551-0117
Fax
(303) 551-0117
NPI assigned
Mar 8, 2022
Last updated
Oct 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
REVIVAL THERAPY SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Authorized official

Name
Sacha LacasseNPI 1326504630
Title
Director
Phone
(720) 441-4622

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

1133 N Pennsylvania St
Denver, CO 80203-2502

Mailing address

1133 N Pennsylvania St
Denver, CO 80203-2502
Phone (303) 551-0117

Other practice location 1

3520 Austin Bluffs Pkwy Ste 101
Colorado Springs, CO 80918-5756
Phone (303) 551-0117

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240802000064 CO Part B Supplier - Clinic/Group Practice 2668919119 Receives reassigned benefits from 4 practitioners
Practice locations: Denver, CO

National Provider Directory

National Provider Directory
Tax ID family
Revival Therapy Services2 organizations share this tax ID, including this one
Part of
Revival Therapy Services

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1133 N Pennsylvania St
Denver, CO 80203
Phone (303) 551-0117

1133 N Pennsylvania St
Bsmt
Denver, CO 80203

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1457008591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 N PENNSYLVANIA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802032502",
            "telephone_number": "303-551-0117",
            "fax_number": "303-551-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 N PENNSYLVANIA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802032502",
            "telephone_number": "303-551-0117",
            "fax_number": "303-551-0117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3520 Austin Bluffs Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809185756",
            "country_code": "US",
            "telephone_number": "303-551-0117",
            "fax_number": "303-551-0117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVAL THERAPY SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REVIVAL THERAPY SERVICES LLC",
        "enumeration_date": "2022-03-08",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "LACASSE",
        "authorized_official_first_name": "SACHA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "720-441-4622"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; 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.