Revival Road Therapy Pllc
NPI #1518716992 in Bloomington, Illinois
Provider Information
- NPI Number
- 1518716992
- Entity Type
- Organization
- Organization Name
- Revival Road Therapy Pllc
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- May 16, 2024
- Last Updated
- May 16, 2024
Practice Location
- Address
- 121 N MAIN ST STE 201
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61701-7619
- Phone
- (309) 204-6260
Authorized Official
- Name
- ALEXIS FRANTZEN CRAWFORD, LCSW
- Title
- OWNER/THERAPIST
- Phone
- (309) 204-6260
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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