REVIVAL ROAD THERAPY PLLC
NPI 1518716992
Social Worker - Clinical in Bloomington, IL

Active since May 16, 2024
121 N MAIN ST STE 201, BLOOMINGTON, IL 61701(309) 204-6260 Get Directions Write a Review

NPPES record last updated: May 16, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Revival Road Therapy Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVAL ROAD THERAPY PLLC (NPI 1518716992), doing business as Revival Road Therapy Llc, is a healthcare organization registered as a clinical in Bloomington, Illinois and active in the NPI registry since May 2024. The organization lists Alexis Frantzen Crawford, Owner/therapist, as its authorized official.

NPPES Registry Identity

NPI1518716992
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameREVIVAL ROAD THERAPY PLLC
Location Address121 N MAIN ST STE 201Bloomington, IL 61701-7619
Mailing Address121 N Main St Ste 201Bloomington, IL 61701-7619 · (309) 204-6260
Organization SubpartNo
Authorized OfficialAlexis Frantzen CrawfordOwner/therapist · (309) 204-6260
Enumeration DateMay 16, 2024
NPPES CertifiedMay 10, 2024
NPI 1518716992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
121 N MAIN ST STE 201, Bloomington, IL 61701

Other Names 1

Former Legal Business NameRevival Road Therapy Llc

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Social Worker (Clinical)
121 N MAIN ST STE 201
BLOOMINGTON, IL 61701

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revival Road Therapy PLLC's NPI number?

The NPI number for Revival Road Therapy PLLC is 1518716992. It was assigned to this organization in the NPPES registry on May 16, 2024. The provider was formerly known as Revival Road Therapy LLC.

Where is Revival Road Therapy PLLC located?

Revival Road Therapy PLLC is located at 121 N Main St Ste 201, Bloomington, IL 61701. The listed phone number is (309) 204-6260.

What is Revival Road Therapy PLLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Revival Road Therapy PLLC was last updated on May 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.