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General NPI Number Information
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NPI Number | 1205662863
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Entity Type | Organization
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Legal Business Name | RESTORE HOPE DNJ THERAPY, PLLC
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 20200 GOVERNORS DR FL 3
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1032
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Country | US
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Telephone | 262-843-5689
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Fax |
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Provider Business Mailing Address
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Address Line | 20200 GOVERNORS DR FL 3
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1032
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Country | US
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Telephone | 262-843-5689
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER BECKHAM
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Credential | LCSW
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Telephone | 708-770-2225
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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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