Provider Demographics
NPI:1174021273
Name:RESTORATION RANCH, LLC
Entity Type:Organization
Organization Name:RESTORATION RANCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:605-351-3718
Mailing Address - Street 1:35686 248TH ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:SD
Mailing Address - Zip Code:57355-6505
Mailing Address - Country:US
Mailing Address - Phone:605-351-3718
Mailing Address - Fax:
Practice Address - Street 1:35540 250TH ST
Practice Address - Street 2:
Practice Address - City:PUKWANA
Practice Address - State:SD
Practice Address - Zip Code:57370-6513
Practice Address - Country:US
Practice Address - Phone:605-351-3718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty