Healthcare Provider Details

I. General information

NPI: 1982548889
Provider Name (Legal Business Name): RESTORATIVE GRACE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 ROE AVE
PRAIRIE VILLAGE KS
66208-2848
US

IV. Provider business mailing address

7416 ROE AVE
PRAIRIE VILLAGE KS
66208-2848
US

V. Phone/Fax

Practice location:
  • Phone: 913-229-6602
  • Fax:
Mailing address:
  • Phone: 913-229-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNA BERTHOLF
Title or Position: OWNER-AUTHORIZED OFFICIAL
Credential: MS
Phone: 913-229-6602