Provider Demographics
NPI:1629610605
Name:RESTORATION HOPE COUNSELING AND NEUROFEEDBACK, PLLC
Entity Type:Organization
Organization Name:RESTORATION HOPE COUNSELING AND NEUROFEEDBACK, PLLC
Other - Org Name:RESTORATION HOPE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, BCN, NCC
Authorized Official - Phone:636-699-7864
Mailing Address - Street 1:6901 S PIERCE ST STE 370
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-7202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 S PIERCE ST STE 370
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-7202
Practice Address - Country:US
Practice Address - Phone:303-775-3684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)