Provider Demographics
NPI:1871909689
Name:REVELATION OF HOPE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:REVELATION OF HOPE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:731-868-7297
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-0934
Mailing Address - Country:US
Mailing Address - Phone:731-487-3595
Mailing Address - Fax:877-273-4824
Practice Address - Street 1:384 CARRIAGE HOUSE DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2268
Practice Address - Country:US
Practice Address - Phone:731-868-7297
Practice Address - Fax:877-273-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2865101YM0800X, 101YP2500X, 101YM0800X
TN990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006062Medicaid