NPIMap

Organization Active NPI

Revolutionary Wellness, PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Georgetown, TX
National Provider Identifier
1609311455
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
REVOLUTIONARY WELLNESS, PLLC
Practice address
213 Sinuso Dr
Georgetown, TX 78628-1533
Phone
(512) 569-4017
NPI assigned
Jan 4, 2017
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
Lisa A Margraves, LCSWNPI 1124566336
Title
Managing Partner
Phone
(512) 569-4017

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary
Professional Counselor 101YP2500X NU
Clinical Social Worker 1041C0700X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

213 Sinuso Dr
Georgetown, TX 78628-1533

Mailing address

213 Sinuso Dr
Georgetown, TX 78628-1533
Phone (512) 569-4017

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190605000865 TX Part B Supplier - Clinic/Group Practice 0648503771 Receives reassigned benefits from 1 practitioner
Practice locations: Georgetown, TX

National Provider Directory

National Provider Directory

Locations

109 W 7th St
Ste 235
Georgetown, TX 78626

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1609311455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 SINUSO DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281533",
            "telephone_number": "512-569-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 SINUSO DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281533",
            "telephone_number": "512-569-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTIONARY WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "MARGRAVES",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "512-569-4017",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.