MEDICARE: RESTORING MINDS COUNSELING SERVICES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568051415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORING MINDS COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	7402 LAKE RIDGE PKWY APT 8323
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-0418
Country	:	US
Telephone Number	:	214-235-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 W MAIN ST
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-2939
Country	:	US
Telephone Number	:	214-235-9087
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE CAMPBELL
Credential	:	LPC
Telephone Number	:	214-235-9087

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	02/13/2024

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