Revel Living LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

REVEL LIVING LLC

Practice address

1740 Ridge Ave Ste 305
Evanston, IL 60201-5909

Phone

(312) 899-6184

NPI assigned

Nov 12, 2018

Last updated

Nov 30, 2020By 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

Mark Vaughan, LMFTNPI 1386190353

Title

Owner/Therapist

Phone

(619) 952-8263

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.

• Mark Vaughan, LMFT

  • Marriage & Family Therapist
  • Evanston, IL
  • NPI 1386190353
  NPD Authorized official

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

{
    "created_epoch": "1541980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1538637277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 CENTRAL ST APT 3",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602016415",
            "telephone_number": "619-952-8263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 RIDGE AVE STE 305",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602015909",
            "telephone_number": "312-899-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVEL LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-12",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "619-952-8263",
        "authorized_official_credential": "LMFT"
    },
    "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": []
}

• Resurrection Services (RMG SFH OB/GYN)
• Resurrection Services
• Resurrection Services
• Resurrection Services (RMG SFH Neurology)
• Resurrection Services
• Rachel Revivo, LCSW
• Polina Reyngold, PSYD
• Colleen Reynolds, PA-C
• Sara E. Reynolds, APN-CNP
• Kaveh Rezaei Bookani, M.D.

• Adult Mental Health Clinic/Center in Evanston, IL
• Providers in Evanston, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.