Provider Demographics
NPI:1710535646
Name:A RESTORED LIFE COUNSELING
Entity Type:Organization
Organization Name:A RESTORED LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSTERLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:208-297-8889
Mailing Address - Street 1:540 S 16TH ST STE 118
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-3514
Mailing Address - Country:US
Mailing Address - Phone:208-297-8889
Mailing Address - Fax:208-485-9475
Practice Address - Street 1:540 S 16TH ST STE 118
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3514
Practice Address - Country:US
Practice Address - Phone:208-297-8889
Practice Address - Fax:208-485-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty