MENTAL HEALTH PRO PA REVIVED WELLNESS
NPI 1366310112
Nurse Practitioner - Psychiatric/Mental Health in San Antonio, TX
About Mental Health Pro Pa Revived Wellness NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MENTAL HEALTH PRO PA REVIVED WELLNESS (NPI 1366310112) is a healthcare organization registered as a psychiatric/mental health in San Antonio, Texas and active in the NPI registry since October 2025. The organization lists Victoria Eneyi Abolarin, Owner Of Entity, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mental Health Pro Pa Revived Wellness is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Mental Health Pro PA Revived Wellness, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Mental Health Pro PA Revived Wellness's NPI number?
The NPI number for Mental Health Pro PA Revived Wellness is 1366310112. It was assigned to this organization in the NPPES registry on October 24, 2025.
Where is Mental Health Pro PA Revived Wellness located?
Mental Health Pro PA Revived Wellness is located at 4400 S Piedras Dr Ste 217, San Antonio, TX 78228. The listed phone number is (210) 903-3383.
What is Mental Health Pro PA Revived Wellness's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Mental Health Pro PA Revived Wellness enrolled in Medicare?
Yes. Mental Health Pro PA Revived Wellness is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mental Health Pro PA Revived Wellness?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Mental Health Pro PA Revived Wellness. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Mental Health Pro PA Revived Wellness accept?
Health plans from Blue Cross and Blue Shield of Texas list Mental Health Pro PA Revived Wellness 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 Mental Health Pro PA Revived Wellness was last updated on March 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Mental Health Pro Pa Revived Wellness · NPI 1366310112
Psychiatric/Mental Health organization in San Antonio, Texas. Organization record, active in the CMS NPPES registry since October 24, 2025.
## Identity
- **NPI:** 1366310112 (Entity type: Organization)
- **Enumerated:** October 24, 2025
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Victoria Abolarin, OWNER OF ENTITY
## Practice location
- **Address:** 4400 S PIEDRAS DR STE 217, San Antonio, TX 78228-1223
- **Phone:** (210) 903-3383
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 5, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1366310112) · Data from the CMS NPPES public registry.