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General NPI Number Information
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NPI Number | 1720708332
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Entity Type | Organization
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Legal Business Name | RESTORATION MIND CENTER LLC
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 5310 DTC PKWY STE A
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3010
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Country | US
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Telephone | 720-577-5546
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Fax | 720-961-5980
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Provider Business Mailing Address
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Address Line | 5310 DTC PKWY STE A
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3010
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Country | US
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Telephone | 720-577-5546
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Fax | 720-961-5980
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Authorized Official
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Title or Position | SOLE PROPRIETOR OWNER
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Name | CARRON MACLEAN
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Credential | LPC
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Telephone | 720-260-6409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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