Provider Demographics
NPI:1487035267
Name:RESTORATION COUNSELING
Entity Type:Organization
Organization Name:RESTORATION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:317-710-7772
Mailing Address - Street 1:415 W BROADWAY ST STE E
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1462
Mailing Address - Country:US
Mailing Address - Phone:317-710-7772
Mailing Address - Fax:
Practice Address - Street 1:415 W BROADWAY ST STE E
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1462
Practice Address - Country:US
Practice Address - Phone:317-710-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000251A101YA0400X
IN35001781A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty