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General NPI Number Information
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NPI Number | 1255948378
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Entity Type | Organization
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Legal Business Name | RESTORE THERAPY & COUNSELING, PLC
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 24 19TH ST SW
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City | SIOUX CENTER
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State | IA
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Zip | 51250-1194
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Country | US
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Telephone | 712-722-5560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | SIOUX CENTER
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State | IA
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Zip | 51250-0023
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Country | US
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Telephone | 712-722-5560
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Fax | 712-722-5561
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Authorized Official
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Title or Position | MANAGER
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Name | NICOLE VAN GINKEL
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Credential |
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Telephone | 712-722-5560
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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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