Provider Demographics
NPI:1326819822
Name:RESTORATION PSYCHOLOGICAL SERVICES PHOENIX PLLC
Entity Type:Organization
Organization Name:RESTORATION PSYCHOLOGICAL SERVICES PHOENIX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD; LMFT
Authorized Official - Phone:623-887-3636
Mailing Address - Street 1:17505 N 79TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8726
Mailing Address - Country:US
Mailing Address - Phone:623-887-3636
Mailing Address - Fax:
Practice Address - Street 1:17505 N 79TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8726
Practice Address - Country:US
Practice Address - Phone:623-887-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty