| Revival Collaborative Llc | |
|
3700 Medical Center Pkwy Bentonville AR 72712-3222 | |
| (479) 721-2110 | |
| Not Available |
| Full Name | Revival Collaborative Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3700 Medical Center Pkwy, Bentonville, Arkansas |
| Authorized Official Name and Position | Zach S Hedges (OWNER) |
| Authorized Official Contact | 4797212110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revival Collaborative Llc 3202 Sw Hazelnut Ave Bentonville AR 72713-3195 Ph: (479) 721-2110 | Revival Collaborative Llc 3700 Medical Center Pkwy Bentonville AR 72712-3222 Ph: (479) 721-2110 |
| NPI Number | 1407515620 |
|---|---|
| Provider Enumeration Date | 12/15/2021 |
| Last Update Date | 12/15/2021 |
| Certification Date | 12/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407515620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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