Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revival Road Therapy PLLC

Organization Clinical Social Worker · NPI 1518716992

Revival Road Therapy PLLC is a Clinical Social Worker in Bloomington, Illinois. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

121 N Main St Ste 201
Bloomington, IL 61701-7619
Phone: (309) 204-6260
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1518716992
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Alexis Frantzen Crawford — Owner/Therapist · (309) 204-6260
Other names Revival Road Therapy Llc
NPI enumeratedMay 16, 2024
Last updated in NPPESMay 16, 2024
Certification dateMay 10, 2024
Mailing address121 N Main St Ste 201, Bloomington, IL 61701-7619

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