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General NPI Number Information
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NPI Number | 1508311333
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Entity Type | Organization
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Legal Business Name | RESTORED HAVEN COUNSELING
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 9896 BISSONNET ST 455
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City | HOUSTON
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State | TX
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Zip | 77036-8104
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Country | US
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Telephone | 832-705-9208
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Fax | 832-941-1136
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Provider Business Mailing Address
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Address Line | 2147 DIAMOND CREST DR
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City | MISSOURI CITY
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State | TX
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Zip | 77489-3285
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Country | US
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Telephone | 832-816-8444
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Fax | 832-941-1136
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | KANDYS RENEE' MCKINLEY
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Credential | MED, LPC, LSOTP
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Telephone | 832-705-9208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67361
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License Number State | TN
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