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Organization
LIFE BRIDGE THERAPY
Active
Organization
LIFE BRIDGE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH CRANDALL LCSW (OWNER)
(217) 329-1346
Entity
Organization
Contact information
Practice address
2507 CURTIS RD, CHAMPAIGN, IL 61822-9630
(217) 329-1346
Mailing address
2507 CURTIS RD, CHAMPAIGN, IL 61822-9630
(217) 329-1346
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149015301
IL
106H00000X
Marriage & Family Therapist
166000861
IL
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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