Provider Demographics
NPI:1962080069
Name:RESTORE THERAPY COLLECTIVE
Entity type:Organization
Organization Name:RESTORE THERAPY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMFT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEN
Authorized Official - Middle Name:CREDIT
Authorized Official - Last Name:HUTCHINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-761-4673
Mailing Address - Street 1:2151 TENWAY DR SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4525
Mailing Address - Country:US
Mailing Address - Phone:248-761-4673
Mailing Address - Fax:616-327-6333
Practice Address - Street 1:2151 TENWAY DR SE
Practice Address - Street 2:
Practice Address - City:EAST GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4525
Practice Address - Country:US
Practice Address - Phone:248-761-4673
Practice Address - Fax:616-327-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty