Provider Demographics
NPI:1306455068
Name:RESTORE FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:RESTORE FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC-SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:405-812-0197
Mailing Address - Street 1:100 W. WILSHIRE
Mailing Address - Street 2:SUITE #C3
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-812-0197
Mailing Address - Fax:
Practice Address - Street 1:100 W. WILSHIRE
Practice Address - Street 2:SUITE #C3
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-812-0197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)