Provider Demographics
NPI:1538642509
Name:RESTORATION FAMILY COUNSELING SERVICES
Entity Type:Organization
Organization Name:RESTORATION FAMILY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-339-8892
Mailing Address - Street 1:5120 E CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4168
Mailing Address - Country:US
Mailing Address - Phone:316-339-8892
Mailing Address - Fax:
Practice Address - Street 1:5120 E CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4168
Practice Address - Country:US
Practice Address - Phone:316-339-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)