Provider Demographics
NPI:1700511284
Name:RESTART PROFESSIONAL GROUP, PLLC
Entity Type:Organization
Organization Name:RESTART PROFESSIONAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COSSETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:800-682-6934
Mailing Address - Street 1:1001 290TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-7403
Mailing Address - Country:US
Mailing Address - Phone:800-682-6934
Mailing Address - Fax:888-788-3419
Practice Address - Street 1:2002 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007
Practice Address - Country:US
Practice Address - Phone:800-682-6934
Practice Address - Fax:888-788-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty