Healthcare Provider Details

I. General information

NPI: 1598418030
Provider Name (Legal Business Name): RESTORED HEALTH ASSOCIATES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 COMMERCE ST
LAUREL MS
39440-3954
US

IV. Provider business mailing address

530 EUCUTTA RD
HEIDELBERG MS
39439-3100
US

V. Phone/Fax

Practice location:
  • Phone: 601-577-2782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BROWNLEE
Title or Position: PRESIDENT
Credential:
Phone: 601-577-2782