Provider Demographics
NPI:1508311333
Name:RESTORED HAVEN COUNSELING
Entity Type:Organization
Organization Name:RESTORED HAVEN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDYS
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, LSOTP
Authorized Official - Phone:832-705-9208
Mailing Address - Street 1:2147 DIAMOND CREST DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3285
Mailing Address - Country:US
Mailing Address - Phone:832-816-8444
Mailing Address - Fax:832-941-1136
Practice Address - Street 1:9896 BISSONNET ST
Practice Address - Street 2:455
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8104
Practice Address - Country:US
Practice Address - Phone:832-705-9208
Practice Address - Fax:832-941-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN67361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty