NPIMap

Organization Active NPI

Psyrev8808 Transformational Center

  • Professional Counselor
  • Philadelphia, PA
National Provider Identifier
1720668122
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
PSYREV8808 TRANSFORMATIONAL CENTER
Practice address
6724 Rising Sun Ave FL 1
Philadelphia, PA 19111-4629
Phone
(267) 255-0386
Fax
(215) 214-5941
NPI assigned
Apr 9, 2021
Last updated
Apr 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Anne Mbette, MPSY, LPCNPI 1306990650
Title
President
Phone
(215) 839-4921

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU Primary

Addresses

Primary practice location

6724 Rising Sun Ave FL 1
Philadelphia, PA 19111-4629

Mailing address

6724 Rising Sun Ave FL 1
Philadelphia, PA 19111-4629
Phone (267) 255-0386

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1720668122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6724 RISING SUN AVE FL 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191114629",
            "telephone_number": "267-255-0386",
            "fax_number": "215-214-5941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6724 RISING SUN AVE FL 1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191114629",
            "telephone_number": "267-255-0386",
            "fax_number": "215-214-5941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYREV8808 TRANSFORMATIONAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "MBETTE",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-839-4921",
        "authorized_official_credential": "MPSY, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; 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.