Provider Demographics
NPI:1447093307
Name:HEALING REVIVAL COLLECTIVE, PLLC
Entity type:Organization
Organization Name:HEALING REVIVAL COLLECTIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-669-4954
Mailing Address - Street 1:1647 N SAWYER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4938
Mailing Address - Country:US
Mailing Address - Phone:312-669-4954
Mailing Address - Fax:
Practice Address - Street 1:1647 N SAWYER AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4938
Practice Address - Country:US
Practice Address - Phone:312-669-4954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty