Revive Therapy LLC
Organization Active NPI Professional Counselor · Troy, OH
NPI 1497437800 · NPPES record last updated Aug 4, 2023
Key facts
- NPI
- 1497437800
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- Legal business name
- REVIVE THERAPY LLC
- Practice address
- 405 Public SQ Ste 350
Troy, OH 45373-5200 - Phone
- (937) 980-3252
- NPI assigned
- Aug 4, 2023
- Organization subpart
- No
Authorized official
- Name
- Michelle Ceyler, LPCC-S, LICDC-CS
- Title
- Owner/Therapist
- Phone
- (937) 216-3904
Practitioners 1
-
Michelle Ceyler, LPCC-S, LICDC-CS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240701003735 | OH | Part B Supplier - Clinic/Group Practice | 8820532807 |
Receives reassigned benefits from 1 practitioner Practice locations: Troy, OH |
National Provider Directory
Locations
462 Washington Ave
Ste 13
North Haven, CT 06473
405 Public Sq
Ste 350
Troy, OH 45373
Phone (352) 258-3611
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | Yes |
Addresses
Primary practice location
405 Public SQ Ste 350
Troy, OH 45373-5200
Mailing address
514 Peters Ave
Troy, OH 45373-3976
Phone (937) 216-3904
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275087454 | Medicaid | OH |
Other providers in Troy, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.