Active NPI
Susan Ann Revak, PCC
- Mental Health Counselor
- Kent, OH
National Provider Identifier
1841480696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- E.0008416.
- Practice address
- 155 N Water St
Kent, OH 44240-2418 - Phone
- (330) 678-3006
- NPI assigned
- Jul 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | E.0008416. | OH | Primary |
Addresses
Primary practice location
155 N Water St
Kent, OH 44240-2418
Mailing address
623 Center Ave
Cuyahoga Falls, OH 44221-2805
Phone (330) 929-9754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.0008416. | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185494400000",
"number": "1841480696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 CENTER AVE",
"city": "CUYAHOGA FALLS",
"state": "OH",
"postal_code": "442212805",
"telephone_number": "330-929-9754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 N WATER ST",
"city": "KENT",
"state": "OH",
"postal_code": "442402418",
"telephone_number": "330-678-3006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVAK",
"first_name": "SUSAN",
"middle_name": "ANN",
"credential": "PCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-27",
"last_updated": "2007-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E.0008416.",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.