MEDICARE: RESTORATIVE EXPEDITION, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1760162135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE EXPEDITION, PLLC

Provider Business Mailing Address
First Line	:	5555 ERINDALE DR STE 107
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6964
Country	:	US
Telephone Number	:	719-354-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 RUSINA RD STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8127
Country	:	US
Telephone Number	:	719-354-5378
Fax Number	:

Authorized Official
Title or Position	:	ONWER
Name	:	HEATHER ORR
Credential	:
Telephone Number	:	719-354-5378

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	02/19/2026

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