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General NPI Number Information
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NPI Number | 1225662166
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Entity Type | Organization
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Legal Business Name | RESTORE COUNSELING SERVICE
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Dates
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Enumeration Date | 03/01/2020
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Last Update Date | 03/01/2020
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Provider Practice Location Address
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Address Line | 1200 FOWLER LN APT C8
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City | CLINTON
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State | TN
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Zip | 37716-3236
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Country | US
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Telephone | 865-770-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 FOWLER LN APT C8
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City | CLINTON
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State | TN
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Zip | 37716-3236
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Country | US
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Telephone | 865-770-3662
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | RICHARD EARL LYONS II
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Credential | LPC
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Telephone | 865-770-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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