Provider Demographics
NPI:1811520307
Name:RESTORATIVE HEALING & COUNSELING, LLC
Entity type:Organization
Organization Name:RESTORATIVE HEALING & COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAYER WITTHOFT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-414-1139
Mailing Address - Street 1:8362 TAMARACK VLG STE 119
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3392
Mailing Address - Country:US
Mailing Address - Phone:651-414-1139
Mailing Address - Fax:
Practice Address - Street 1:385 LONDIN PLACE
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119
Practice Address - Country:US
Practice Address - Phone:651-414-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty