Provider Demographics
NPI:1245852375
Name:RESTORATION FAMILY THERAPY, L.L.C.
Entity type:Organization
Organization Name:RESTORATION FAMILY THERAPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:DOREMUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:907-726-3572
Mailing Address - Street 1:PO BOX 670813
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0813
Mailing Address - Country:US
Mailing Address - Phone:907-726-3572
Mailing Address - Fax:
Practice Address - Street 1:23554 BLUE SKIES DR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5640
Practice Address - Country:US
Practice Address - Phone:907-726-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty