Revival Road Therapy PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REVIVAL ROAD THERAPY PLLC

Practice address

121 N Main St Ste 201
Bloomington, IL 61701-7619

Phone

(309) 204-6260

NPI assigned

May 16, 2024

Organization subpart

No

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

Authorized official

Name

Alexis Frantzen Crawford, LCSWNPI 1871349191

Title

Owner/Therapist

Phone

(309) 204-6260

Specialties & licenses 1

Addresses

Other names 1

• Revival Road Therapy LLC Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexis Marie Frantzen-Crawford, LCSW

  • Clinical Social Worker
  • Bloomington, IL
  • NPI 1871349191
  NPD Authorized official

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

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1518716992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N MAIN ST STE 201",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017619",
            "telephone_number": "309-204-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N MAIN ST STE 201",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017619",
            "telephone_number": "309-204-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL ROAD THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "FRANTZEN CRAWFORD",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "309-204-6260",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revival Road Therapy LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Social Worker in Bloomington, IL
• Providers in Bloomington, 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 May 16, 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.