Life Bridge Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149015301 Issued in IL

Legal business name

LIFE BRIDGE THERAPY

Practice address

2507 Curtis Rd
Champaign, IL 61822-9630

Phone

(217) 329-1346

NPI assigned

Oct 15, 2014

Organization subpart

No

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

Authorized official

Name

Deborah Crandall, LCSW

Title

Owner

Phone

(217) 329-1346

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1235533506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 CURTIS RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618229630",
            "telephone_number": "217-329-1346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 CURTIS RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618229630",
            "telephone_number": "217-329-1346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BRIDGE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "CRANDALL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-329-1346",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015301",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000861",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul K Li, MD
• Charles C Liang, DO
• Jennifer Lieb, NP
• Leeann Lietz
• Clarissa Liew, MD
• Lifetime Dental Care of Illinois, PC
• Lifetime Dental Care of Illinois, PC
• Domica Shanta Light
• Christopher Todd Lighty, LSW
• Huiyi Lin, RN

• Clinical Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.