RESEREVELATIONS LLC NPI 1083326706

NPI Information

NPI: 1083326706
Provider Name: RESEREVELATIONS, LLC
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

Address:
4440 N UNION RD
TROTWOOD, OH
ZIP 45426
Phone: (937) 350-1684
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RESEREVELATIONS, LLC is an adolescent and children mental health clinic center in Trotwood, OH. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. RESEREVELATIONS, LLC NPI is 1083326706. The provider is registered as an organization entity type.

The provider's business location address is:

4440 N UNION RD
TROTWOOD, OH
ZIP 45426
Phone: (937) 350-1684

The provider's authorized official is De'rese Zyire Gooden .
The authorized official title is Licensed Professional Counselor and has the following contact phone number (513) 328-8516.

The enumeration date for this NPI number is 12/14/2022 and was last updated on 12/17/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	251B00000X	Case Management		No
2	251K00000X	Public Health or Welfare		No
3	251S00000X	Community/Behavioral Health		No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
5	261QM0850X	Clinic/Center	Adult Mental Health	No
6	347C00000X	Private Vehicle		No
7	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0307155	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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