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REVIVE BEHAVIORAL HEALTH, LLC
NPI 1003601220
Nurse Practitioner - Psychiatric/Mental Health in Mount Vernon, OH

Active since April 09, 2025CLIA 36D2326643 · Waiver
206 S MULBERRY ST STE A, MOUNT VERNON, OH 43050(740) 501-4836 Get Directions Write a Review

NPPES record last updated: April 10, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Revive Behavioral Health, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVE BEHAVIORAL HEALTH, LLC (NPI 1003601220) is a healthcare organization registered as a psychiatric/mental health in Mount Vernon, Ohio and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through July 7, 2027 and lists Jordan R Moore, Owner, as its authorized official.

NPPES Registry Identity

NPI1003601220
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameREVIVE BEHAVIORAL HEALTH, LLC
Location Address206 S MULBERRY ST STE AMount Vernon, OH 43050-3331
Mailing Address6130 Sharp RdMount Vernon, OH 43050-9477
Phone(740) 501-4836
Organization SubpartNo
Authorized OfficialJordan R MooreOwner · (740) 501-4836
Enumeration DateApril 9, 2025
Last NPPES UpdateApril 10, 2025
NPPES CertifiedApril 10, 2025
✔ NPI 1003601220 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
206 S MULBERRY ST STE A, Mount Vernon, OH 43050
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D2326643

Revive Behavioral Health · Mount Vernon, OH
Active · expires Jul 7, 2027
CLIA Number36D2326643
Laboratory TypePhysician Office
Certificate Effective DateJuly 8, 2025
Certificate Expiration DateJuly 7, 2027
Laboratory DirectorJordan R. Moore
Laboratory Phone(740) 326-9988
Laboratory LocationRevive Behavioral Health206 S Mulberry Street, Suite A, Mount Vernon, OH 43050
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JACQUELINE JEAN PACK
Social Worker
206 S MULBERRY ST STE A
MOUNT VERNON, OH 43050
Knox County (740) 326-9988
BRITNEY MCPEEK APRN
Nurse Practitioner (Psychiatric/Mental Health)
206 S MULBERRY ST STE A
MOUNT VERNON, OH 43050
Knox County (740) 326-1231
SIMONA LYDIA MOORE C.N.P.
Nurse Practitioner (Family)
206 S MULBERRY ST STE A
MOUNT VERNON, OH 43050
Knox County (330) 473-2569
JORDAN RUSSELL MOORE
Nurse Practitioner (Psychiatric/Mental Health)
206 S MULBERRY ST STE A
MOUNT VERNON, OH 43050
Knox County (740) 326-9988

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Behavioral Health, LLC's NPI number?

The NPI number for Revive Behavioral Health, LLC is 1003601220. It was assigned to this organization in the NPPES registry on April 9, 2025.

Where is Revive Behavioral Health, LLC located?

Revive Behavioral Health, LLC is located at 206 S Mulberry St Ste A, Mount Vernon, OH 43050. The listed phone number is (740) 501-4836.

What is Revive Behavioral Health, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Does Revive Behavioral Health, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D2326643) is associated with this NPI, valid through July 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Revive Behavioral Health, LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and Anthem Blue Cross and Blue Shield list Revive Behavioral Health, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Revive Behavioral Health, LLC was last updated on April 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.