| NPI | 1902604531 |
|---|---|
| Former Legal Business Name | REVIVE NEUROFEEDBACK |
| Entity Type | Organization |
| Authorized Contact | ALISSA PRIEB Operations Officer 541-606-9947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-03-07 |