Basic Information
| Provider Information | |||||||||
| NPI: | 1821316258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REVITALIZING HOPE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1250 | ||||||||
| Address2: | |||||||||
| City: | GUTHRIE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730441250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058313202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6003 N ROBINSON AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058313202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2010 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | BOBBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4058313202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.