Provider Demographics
NPI:1669938957
Name:RESTORATION COUNSELING CENTER LLC
Entity type:Organization
Organization Name:RESTORATION COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW,LCSW
Authorized Official - Phone:765-576-0778
Mailing Address - Street 1:7817 S 750 E
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:IN
Mailing Address - Zip Code:47355-9398
Mailing Address - Country:US
Mailing Address - Phone:765-576-0778
Mailing Address - Fax:
Practice Address - Street 1:120 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4119
Practice Address - Country:US
Practice Address - Phone:765-576-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health