Healthcare Provider Details

I. General information

NPI: 1669391462
Provider Name (Legal Business Name): THE RESTORATION HAVEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 N LAUREL AVE
SPRINGFIELD MO
65803-1134
US

IV. Provider business mailing address

513 US HIGHWAY 60 E UNIT 836
REPUBLIC MO
65738-1320
US

V. Phone/Fax

Practice location:
  • Phone: 417-763-8662
  • Fax:
Mailing address:
  • Phone:
  • 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: ALLY PAIGE ALLEN
Title or Position: OWNER/LPC
Credential: MS, MSW, LPC
Phone: 417-763-8662