Healthcare Provider Details

I. General information

NPI: 1346004066
Provider Name (Legal Business Name): RESTORATIVE THERAPY & PSYCHIATRIC CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PAINE ST
DECORAH IA
52101-2411
US

IV. Provider business mailing address

504 2ND ST W
CRESCO IA
52136-1334
US

V. Phone/Fax

Practice location:
  • Phone: 563-379-8969
  • Fax:
Mailing address:
  • Phone: 563-379-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. AMY MILLAGE
Title or Position: CO-OWNER
Credential: ARNP, PMHNP-BC
Phone: 563-379-8969