Organization
PSYCH REVIVAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLE SPROWSO LCSW (CEO)
(970) 208-7791
Entity
Organization
Contact information
Practice address
1675 E SEMINOLE ST, SPRINGFIELD, MO 65804-2490
(970) 208-7791
Mailing address
3097 N DICKERSON AVE, SPRINGFIELD, MO 65803-1267
(970) 208-7791
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/01/2024
Last updated
11/01/2024
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