Healthcare Provider Details

I. General information

NPI: 1346048261
Provider Name (Legal Business Name): RESTORATION COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 STATE ROUTE 116
GERMANTOWN HILLS IL
61548-7612
US

IV. Provider business mailing address

102 BRIAR CT
WASHINGTON IL
61571-1905
US

V. Phone/Fax

Practice location:
  • Phone: 309-265-6406
  • Fax:
Mailing address:
  • Phone: 309-265-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JOAN SEIDL
Title or Position: OWNER
Credential: LCPC
Phone: 309-265-6406