Provider Demographics
NPI:1154362945
Name:RESTORATION ODYSSEY INC
Entity type:Organization
Organization Name:RESTORATION ODYSSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LOFTON
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,LCDC,LCCA
Authorized Official - Phone:281-442-4900
Mailing Address - Street 1:PO BOX 111338
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-0338
Mailing Address - Country:US
Mailing Address - Phone:281-442-4900
Mailing Address - Fax:281-442-4904
Practice Address - Street 1:2814 ALDINE BENDER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3502
Practice Address - Country:US
Practice Address - Phone:281-442-4900
Practice Address - Fax:281-442-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty