Provider Demographics
NPI:1245866540
Name:RESTORATION HOPE COUNSELING AND NEUROFEEDBACK, PLLC
Entity type:Organization
Organization Name:RESTORATION HOPE COUNSELING AND NEUROFEEDBACK, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-699-7864
Mailing Address - Street 1:7921 SOUTHPARK PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4506
Mailing Address - Country:US
Mailing Address - Phone:303-775-3684
Mailing Address - Fax:
Practice Address - Street 1:7921 SOUTHPARK PLZ STE 204
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4506
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:2020-03-18
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health