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General NPI Number Information
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NPI Number | 1083520662
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Entity Type | Organization
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Legal Business Name | RESTORATIVE MIND THERAPY, LLC
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 1802 WOODDALE DR STE 102
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City | WOODBURY
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State | MN
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Zip | 55125-2919
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Country | US
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Telephone | 651-399-0979
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 GLENROSS RD
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City | WOODBURY
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State | MN
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Zip | 55125-4006
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Country | US
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Telephone | 651-399-0979
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPY
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Name | SHARI MARIK-ROACH
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Credential | LICSW
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Telephone | 651-399-0979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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