Psych Revival Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PSYCH REVIVAL THERAPY LLC

Practice address

1675 E Seminole St
Springfield, MO 65804-2490

Phone

(970) 208-7791

NPI assigned

Nov 1, 2024

Last updated

Nov 1, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nichole Sprowso, LCSWNPI 1609604347

Title

Ceo

Phone

(970) 208-7791

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nichole Sprowso, LCSW

  • Clinical Social Worker
  • Springfield, MO
  • NPI 1609604347
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1184447955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3097 N DICKERSON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658031267",
            "telephone_number": "970-208-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 E SEMINOLE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042490",
            "telephone_number": "970-208-7791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCH REVIVAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-01",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "SPROWSO",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-208-7791",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Annette Pruett, RN
• Timothy O Pruett, FNP
• Lisa Pruitt, MS, PLPC
• Alicia Pry, CPHT, CHW-C
• Psych Associates LLC
• Psychology Services, PC
• Bailey A Puckett, MS, LPC
• Samantha Puhl, PA
• Joseph Allen Pulleyking, PSY.D.
• Pulmonary Specialists of the Ozarks, LLC

• Clinical Social Worker in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.