Revive Wellness

NPI #1639885171 in Crookston, Minnesota

Provider Information

NPI Number: 1639885171
Entity Type: Organization
Organization Name: Revive Wellness
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Jan 27, 2023
Last Updated: Jan 27, 2023

Practice Location

Address: 116 W ROBERT ST STE 2B
City: Crookston
State: Minnesota
ZIP Code: 56716-1709
Phone: (218) 289-7023

Authorized Official

Name: MRS. JESSICA NICHOLE SHOCKMAN, LICSW
Title: MENTAL HEALTH PROFESSIONAL
Phone: (218) 289-7023

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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