Provider Demographics
NPI:1225662166
Name:RESTORE COUNSELING SERVICE
Entity Type:Organization
Organization Name:RESTORE COUNSELING SERVICE
Other - Org Name:RESTORE COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:865-770-3662
Mailing Address - Street 1:1200 FOWLER LN APT C8
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3236
Mailing Address - Country:US
Mailing Address - Phone:865-770-3662
Mailing Address - Fax:
Practice Address - Street 1:1200 FOWLER LN APT C8
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3236
Practice Address - Country:US
Practice Address - Phone:865-770-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty