Healthcare Provider Details

I. General information

NPI: 1992429740
Provider Name (Legal Business Name): RESTORATIVE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 INDUSTRY DR STE 108C
BASTROP TX
78602-4603
US

IV. Provider business mailing address

1604 INDUSTRY DR STE 108C
BASTROP TX
78602-4603
US

V. Phone/Fax

Practice location:
  • Phone: 737-251-5707
  • Fax: 737-222-4463
Mailing address:
  • Phone: 737-222-4463
  • Fax: 737-238-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA L. WEBER
Title or Position: CLINICAL DIRECTOR
Credential: LPCC/LPC
Phone: 737-251-5707