Provider Demographics
NPI:1619753274
Name:MIND RESTORATION, LLC
Entity Type:Organization
Organization Name:MIND RESTORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTIGHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-951-2483
Mailing Address - Street 1:3545 BROAD ST UNIT 660156
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30366-2123
Mailing Address - Country:US
Mailing Address - Phone:404-275-4604
Mailing Address - Fax:
Practice Address - Street 1:3545 BROAD ST UNIT 660156
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30366-2123
Practice Address - Country:US
Practice Address - Phone:404-275-4604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty