Provider Demographics
NPI:1275425456
Name:REVITAL PATH COUNSELING LLC
Entity type:Organization
Organization Name:REVITAL PATH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,NCC
Authorized Official - Phone:225-776-7156
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70765-0084
Mailing Address - Country:US
Mailing Address - Phone:225-776-7156
Mailing Address - Fax:
Practice Address - Street 1:24425 HOLLY DR
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3874
Practice Address - Country:US
Practice Address - Phone:225-776-7156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty