Revive Wellco

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

REVIVE WELLCO

Practice address

518 Latham CT.
Clarksville, TN 37043

Phone

(501) 318-3760

NPI assigned

Jul 17, 2023

Organization subpart

No

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

Authorized official

Name

Jennifer Schalow, LPC-SNPI 1043545700

Title

Ceo

Phone

(501) 318-3760

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Schalow, LPC

  • Mental Health Counselor
  • Clarksville, TN
  • NPI 1043545700
  NPD Authorized official

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1851070882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 TINY TOWN RD",
            "address_2": "SUITE B #2021",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370427660",
            "telephone_number": "501-318-3760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 LATHAM CT.",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "501-318-3760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 N Royal St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223143271",
            "country_code": "US",
            "telephone_number": "501-318-3760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE WELLCO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-17",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "SCHALOW",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-318-3760",
        "authorized_official_credential": "LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Results-Ast JV, LLC
• Results-Ast JV, LLC
• Results-Ast JV, LLC
• Results-Ast JV, LLC
• Results-Ast JV, LLC
• Tania Reyes Gonzales
• Dannielhys Marie Reyes Hernandez
• Adriana Reyes
• Brenda Faye Reynolds, LVN
• Kaitlyn Reynolds

• Mental Health Counselor in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.