NPI 1073077418

Robert Revell, CPSS

Practitioner Peer Specialist Gulfport, MS

Practice location

Address: 1600 Broad Ave, Gulfport, MS 39501-3603
Phone: (228) 865-1719
Fax: (228) 865-1780

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence 390 (MS)

Other Peer Specialist providers in Mississippi →

Registry record

NPI: 1073077418
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jan 2019
Record last updated: 12 Jul 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.