Provider Demographics
NPI:1568199768
Name:RESTORATION COUNSELING AND NEUROFEEDBACK CENTER, LLP
Entity Type:Organization
Organization Name:RESTORATION COUNSELING AND NEUROFEEDBACK CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-656-2623
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-0762
Mailing Address - Country:US
Mailing Address - Phone:580-656-2623
Mailing Address - Fax:833-685-0702
Practice Address - Street 1:324 S HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-2929
Practice Address - Country:US
Practice Address - Phone:580-656-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty