Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Life Revival LLC

Organization Mental Health Counselor · NPI 1023701067

Life Revival LLC is a Mental Health Counselor in Philadelphia, Pennsylvania. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
15
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6404 Roosevelt Blvd
Philadelphia, PA 19149-2943
Phone: (267) 577-7747
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Behavioral Health Agency (primary) Taxonomy 251S00000X
Mental Health Counselor Taxonomy 101YM0800X
Counseling Psychologist Taxonomy 103TC1900X
Family Psychologist Taxonomy 103TF0000X
Psychoanalysis Psychologist Taxonomy 103TP0814X
Group Psychotherapy Psychologist Taxonomy 103TP2701X
Clinical Social Worker Taxonomy 1041C0700X
Psychiatry Physician Taxonomy 2084P0800X
Child & Adolescent Psychiatry Physician Taxonomy 2084P0804X
Geriatric Psychiatry Physician Taxonomy 2084P0805X
Case Management Agency Taxonomy 251B00000X
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X
Adult Mental Health Clinic/Center Taxonomy 261QM0850X
Adolescent and Children Mental Health Clinic/Center Taxonomy 261QM0855X
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X

Record details

NPI number1023701067
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Daniel Lee — Director · (267) 259-4558
Other names Life Revival, Llc
NPI enumeratedMay 26, 2023
Last updated in NPPESFebruary 11, 2025
Certification dateFebruary 11, 2025
Mailing address6404 Roosevelt Blvd, Philadelphia, PA 19149-2943

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