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

Revival Psychiatry and Ketamine Clinic

Organization Multi-Specialty Clinic/Center · NPI 1235847286

Revival Psychiatry and Ketamine Clinic is a Multi-Specialty Clinic/Center in Mesa, Arizona. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
2

Practice location Address checks out

1220 S Alma School Rd Ste 212
Mesa, AZ 85210-2087
Phone: (480) 613-8162
Fax: (480) 900-8654
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X
Multi-Specialty Clinic/Center Taxonomy 261QM1300X

Record details

NPI number1235847286
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Erin Jones — Owner/Provider · (480) 613-8162
NPI enumeratedNovember 8, 2022
Last updated in NPPESNovember 8, 2022
Certification dateNovember 8, 2022
Mailing address1220 S Alma School Rd Ste 212, Mesa, AZ 85210-2087

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