Provider Demographics
NPI:1588085377
Name:RESTORE COUNSELING SERVICES
Entity type:Organization
Organization Name:RESTORE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MYIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS-BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, BCPC
Authorized Official - Phone:225-305-8886
Mailing Address - Street 1:4705 SECRETARY DR
Mailing Address - Street 2:STE. A
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4070
Mailing Address - Country:US
Mailing Address - Phone:225-305-8886
Mailing Address - Fax:225-282-2221
Practice Address - Street 1:4705 SECRETARY DR
Practice Address - Street 2:STE. A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4070
Practice Address - Country:US
Practice Address - Phone:225-305-8886
Practice Address - Fax:225-282-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty