MEDICARE: TRAUMA RESTORATION INSTITUTE & COUNSELING CENTER LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1558212233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA RESTORATION INSTITUTE & COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	19 HONOR DR
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-2815
Country	:	US
Telephone Number	:	762-261-1090
Fax Number	:	833-806-0717

Provider Business Practice Location Address
First Line	:	19 HONOR DR
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-2815
Country	:	US
Telephone Number	:	762-261-1090
Fax Number	:	833-806-0717

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. GREGORY ROY SMITH SR.
Credential	:	LPC
Telephone Number	:	762-261-1090

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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