MEDICARE: RESTORATION COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1084	CO

General Provider Information

NPI Number	:	1265899744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION COUNSELING

Provider Business Mailing Address
First Line	:	4283 COOLWATER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-5548
Country	:	US
Telephone Number	:	719-761-3217
Fax Number	:	719-218-9550

Provider Business Practice Location Address
First Line	:	6270 LEHMAN DR STE 200D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1470
Country	:	US
Telephone Number	:	719-761-3217
Fax Number	:	719-218-9550

Authorized Official
Title or Position	:	OWNER
Name	:	SHELDON MCGUIRE
Credential	:	LMFT
Telephone Number	:	719-761-3217

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	01/28/2016

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