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Organization
REVIVAL ROAD THERAPY PLLC
Active
Organization
REVIVAL ROAD THERAPY PLLC
Active
Other names
Revival Road Therapy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS FRANTZEN CRAWFORD LCSW (OWNER/THERAPIST)
(309) 204-6260
Entity
Organization
Contact information
Practice address
121 N MAIN ST STE 201, BLOOMINGTON, IL 61701-7619
(309) 204-6260
Mailing address
121 N MAIN ST STE 201, BLOOMINGTON, IL 61701-7619
(309) 204-6260
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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