| Psych Revival Therapy Llc | |
|
1675 E Seminole St Springfield MO 65804-2490 | |
| (970) 208-7791 | |
| Not Available |
| Full Name | Psych Revival Therapy Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1675 E Seminole St, Springfield, Missouri |
| Authorized Official Name and Position | Nichole Sprowso (CEO) |
| Authorized Official Contact | 9702087791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Revival Therapy Llc 3097 N Dickerson Ave Springfield MO 65803-1267 Ph: (970) 208-7791 | Psych Revival Therapy Llc 1675 E Seminole St Springfield MO 65804-2490 Ph: (970) 208-7791 |
| NPI Number | 1184447955 |
|---|---|
| Provider Enumeration Date | 11/01/2024 |
| Last Update Date | 11/01/2024 |
| Certification Date | 11/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184447955 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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