NPIMap

Organization Active NPI

Revival Therapy, P.C.

  • Professional Counselor
  • Crystal Lake, IL
National Provider Identifier
1376150896
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
REVIVAL THERAPY, P.C.
Practice address
330 W. Terra Cotta Ave.
Suite a
Crystal Lake, IL 60014
Phone
(815) 382-9691
Fax
(815) 800-0670
NPI assigned
Sep 29, 2020
Last updated
Aug 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Authorized official

Name
Ms. Sara Lemke, LCPC, CADCNPI 1932427275
Title
Ceo/Practice Owner
Phone
(815) 451-6585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

330 W. Terra Cotta Ave.
Suite a
Crystal Lake, IL 60014

Mailing address

330 W. Terra Cotta Ave.
Suite a
Crystal Lake, IL 60014
Phone (815) 382-9691

Other names 1

  • Revival Therapy, Inc. Former legal business name

National Provider Directory

National Provider Directory

Locations

330 W Terra Cotta Ave
Ste 4
Crystal Lake, IL 60014
Phone (815) 382-9691

330 W Terra Cotta Ave
Ste A
Crystal Lake, IL 60014
Phone (815) 382-9691

42 East St
Crystal Lake, IL 60014

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1376150896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 W. TERRA COTTA AVE.",
            "address_2": "SUITE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-382-9691",
            "fax_number": "815-800-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W. TERRA COTTA AVE.",
            "address_2": "SUITE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-382-9691",
            "fax_number": "815-800-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL THERAPY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-29",
        "last_updated": "2024-08-09",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO/PRACTICE OWNER",
        "authorized_official_telephone_number": "815-451-6585",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC, CADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revival Therapy, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; 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.