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General NPI Number Information
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NPI Number | 1194692004
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Entity Type | Organization
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Legal Business Name | RESTORED GROUND THERAPY AND COUNSELING LLC
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 300 GARDEN OF THE GODS ROAD SUITE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907
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Country | US
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Telephone | 719-413-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 E FOUNTAIN BLVD STE 106
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-9300
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Country | US
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Telephone | 719-413-8350
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MS. KRISTIN BOTHWELL
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Credential | LCSW
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Telephone | 719-413-8350
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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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