Provider Demographics
NPI:1013622406
Name:RESTORATIVE MIND THERAPY LLC
Entity Type:Organization
Organization Name:RESTORATIVE MIND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROESLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-837-1331
Mailing Address - Street 1:5337 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6018
Mailing Address - Country:US
Mailing Address - Phone:405-837-1331
Mailing Address - Fax:
Practice Address - Street 1:5908 W HEFNER RD STE 1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4947
Practice Address - Country:US
Practice Address - Phone:405-837-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty