| Revolutionary Wellness,pllc | |
|
109 W 7th St Suite 235 Georgetown TX 78626-5763 | |
| (512) 788-5634 | |
| Not Available |
| Full Name | Revolutionary Wellness,pllc |
|---|---|
| Speciality | Social Worker |
| Location | 109 W 7th St, Georgetown, Texas |
| Authorized Official Name and Position | Lisa A Margraves (MANAGING PARTNER) |
| Authorized Official Contact | 5125694017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolutionary Wellness,pllc 109 W 7th St Suite 235 Georgetown TX 78626-5763 Ph: (512) 788-5634 | Revolutionary Wellness,pllc 109 W 7th St Suite 235 Georgetown TX 78626-5763 Ph: (512) 788-5634 |
| NPI Number | 1609311455 |
|---|---|
| Provider Enumeration Date | 01/04/2017 |
| Last Update Date | 01/04/2017 |
| Medicare PECOS PAC ID | 0648503771 |
|---|---|
| Medicare Enrollment ID | O20190605000865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609311455 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 69805 (Texas) | Secondary |
| 1041C0700X | Social Worker - Clinical | 39121 (Texas) | Primary |
| Provider Name | Lisa A Margraves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124566336 PECOS PAC ID: 0244563377 Enrollment ID: I20190605001737 |
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