Revival Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REVIVAL COUNSELING LLC

Practice address

7264 S Woodrow Dr
Pendleton, IN 46064-9102

Phone

(814) 282-5489

NPI assigned

Aug 31, 2021

Organization subpart

No

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

Authorized official

Name

Kaylee Durnell, LCSW

Title

Owner/Therapist

Phone

(814) 282-5489

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1821766320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7264 S WOODROW DR",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "460649102",
            "telephone_number": "814-282-5489",
            "fax_number": "765-227-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7264 S WOODROW DR",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "460649102",
            "telephone_number": "814-282-5489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 W Broadway St",
            "address_purpose": "LOCATION",
            "city": "Ingalls",
            "state": "IN",
            "postal_code": "460489500",
            "country_code": "US",
            "telephone_number": "814-282-5489",
            "fax_number": "765-227-2162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVAL COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "DURNELL",
        "authorized_official_first_name": "KAYLEE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "814-282-5489",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Pendleton, IN
• Providers in Pendleton, IN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.