MEDICARE: RESTORE COUNSELING & RECOVERY, INC.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	27402	IL
2	106H00000X	Marriage & Family Therapist	166000729	IL
3	1041C0700X	Clinical Social Worker	149012902	IL

General Provider Information

NPI Number	:	1588909923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE COUNSELING & RECOVERY, INC.

Provider Business Mailing Address
First Line	:	7399 FOREST HILLS RD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-3974
Country	:	US
Telephone Number	:	815-708-7392
Fax Number	:	815-708-8248

Provider Business Practice Location Address
First Line	:	7399 FOREST HILLS RD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-3974
Country	:	US
Telephone Number	:	815-708-7392
Fax Number	:	815-708-8248

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS G MLODZIK
Credential	:	LCSW LMFT CRADC
Telephone Number	:	414-324-9332

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	08/18/2023

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