Healthcare Provider Details

I. General information

NPI: 1205362704
Provider Name (Legal Business Name): RESTORED COUNSELING AND CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 18TH ST STE 412
MONROE LA
71201-4419
US

IV. Provider business mailing address

77 HIGHWAY 135
RAYVILLE LA
71269-5556
US

V. Phone/Fax

Practice location:
  • Phone: 318-680-3767
  • Fax:
Mailing address:
  • Phone: 318-235-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4845
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4845
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4845
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4845
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. AMANDA WHATLEY MILLER
Title or Position: OWNER
Credential: LPC-SA
Phone: 318-235-4798