Revitalize Minds Counseling

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REVITALIZE MINDS COUNSELING

Practice address

312 N Missouri St Ste 1
West Memphis, AR 72301-3186

Phone

(870) 796-8997

Fax

(870) 796-8998

NPI assigned

Jul 29, 2022

Last updated

Jan 16, 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

Tangella Michelle Foreman, LCSWNPI 1609164730

Title

Therapist

Phone

(870) 926-7344

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

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.

• Tangella Foreman, LCSW

  • Clinical Social Worker
  • Marion, AR
  • NPI 1609164730
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1659052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1467188664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 N MISSOURI ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013142",
            "telephone_number": "870-796-8997",
            "fax_number": "870-796-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 N MISSOURI ST STE 1",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013186",
            "telephone_number": "870-796-8997",
            "fax_number": "870-796-8998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "927 Bayou Vista Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "AR",
            "postal_code": "723645076",
            "country_code": "US",
            "telephone_number": "870-926-7344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVITALIZE MINDS COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-29",
        "last_updated": "2023-01-16",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "FOREMAN",
        "authorized_official_first_name": "TANGELLA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "870-926-7344",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Refining Touch Behavioral Health & Recovery
• Refining Touch Transportation Services LLC
• Devonda Yvonne Reimonenq-Curry, LCSW
• Resources Coordination Inc
• Restoring Hope Counseling and Consultation
• Zachary Reynolds, DPT
• Rosa Richardson, LPC
• Tiffanni Richardson
• Robert Chin MD PHD LLC (Midsouth Womens Clinic)
• Deirdre Robinson

• Clinical Social Worker in West Memphis, AR
• Providers in West Memphis, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; 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.