Provider Demographics
NPI:1073401295
Name:REVITALIZE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:REVITALIZE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SAINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-284-7950
Mailing Address - Street 1:1486 KENWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1133
Mailing Address - Country:US
Mailing Address - Phone:920-284-7950
Mailing Address - Fax:
Practice Address - Street 1:1486 KENWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1133
Practice Address - Country:US
Practice Address - Phone:920-284-7950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty