Provider Demographics
NPI:1700487816
Name:TOTAL RESTORATION BEHAVIORAL SCIENCE AND COUNSELING CENTER
Entity Type:Organization
Organization Name:TOTAL RESTORATION BEHAVIORAL SCIENCE AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EARNEST
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, DMIN
Authorized Official - Phone:301-556-8665
Mailing Address - Street 1:9659 N SAM HOUSTON PKWY E # 227
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1529
Mailing Address - Country:US
Mailing Address - Phone:301-556-8665
Mailing Address - Fax:
Practice Address - Street 1:9823 BRILLIANT LAKE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1570
Practice Address - Country:US
Practice Address - Phone:301-556-8665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No286500000XHospitalsMilitary Hospital
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness