Revive Health Clinics, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

REVIVE HEALTH CLINICS, PLLC

Practice address

1277 E Missouri Ave Ste 101
Phoenix, AZ 85014-2916

Phone

(602) 296-4106

Fax

(602) 296-4146

NPI assigned

Jun 24, 2021

Organization subpart

No

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

Authorized official

Name

Joshua F Bock

Title

Managing Member

Phone

(480) 726-2287

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1780253500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 S ALMA SCHOOL RD STE 354",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103028",
            "telephone_number": "480-726-2287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1277 E MISSOURI AVE STE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142916",
            "telephone_number": "602-296-4106",
            "fax_number": "602-296-4146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14239 W Bell Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853742470",
            "country_code": "US",
            "telephone_number": "602-296-4106",
            "fax_number": "602-296-4146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE HEALTH CLINICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "BOCK",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "480-726-2287"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.