| NPI | 1518716992 |
|---|---|
| Former Legal Business Name | REVIVAL ROAD THERAPY LLC |
| Entity Type | Organization |
| Authorized Contact | ALEXIS FRANTZEN CRAWFORD Owner/Therapist 309-204-6260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |