Provider Demographics
NPI:1003370651
Name:RESTORATIVE PLACE LLC
Entity Type:Organization
Organization Name:RESTORATIVE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-259-3834
Mailing Address - Street 1:2790 N ACADEMY BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5328
Mailing Address - Country:US
Mailing Address - Phone:719-259-3834
Mailing Address - Fax:
Practice Address - Street 1:2790 N ACADEMY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5328
Practice Address - Country:US
Practice Address - Phone:719-259-3834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty