| NPI | 1376150896 |
|---|---|
| Former Legal Business Name | REVIVAL THERAPY, INC. |
| Entity Type | Organization |
| Authorized Contact | SARA LEMKE CEO/Practice Owner 815-451-6585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2024-08-09 |