Provider Demographics
NPI:1497057236
Name:FAMILY RESTORATION COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:FAMILY RESTORATION COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:214-668-9628
Mailing Address - Street 1:6010 BLUEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-6337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8340 MEADOW RD
Practice Address - Street 2:STE 134
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3769
Practice Address - Country:US
Practice Address - Phone:214-265-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health