Healthcare Provider Details

I. General information

NPI: 1922934157
Provider Name (Legal Business Name): RESTORATIVE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W CENTER ST STE L200
POCATELLO ID
83204-4205
US

IV. Provider business mailing address

845 W CENTER ST STE L200
POCATELLO ID
83204-4205
US

V. Phone/Fax

Practice location:
  • Phone: 208-675-9412
  • Fax: 208-906-1397
Mailing address:
  • Phone: 208-675-9412
  • Fax: 208-906-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PEPPER BECKSTEAD
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 208-675-9412