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General NPI Number Information
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NPI Number | 1730993551
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Entity Type | Organization
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Legal Business Name | GREATER RESTORATION COUNSELING LLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 304 N WALNUT ST
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City | PLYMOUTH
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State | IN
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Zip | 46563-1768
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Country | US
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Telephone | 518-466-4972
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Fax |
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Provider Business Mailing Address
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Address Line | 902 LAKE AVE
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City | PLYMOUTH
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State | IN
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Zip | 46563-2415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | EMILY MATSON
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Credential | MS
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Telephone | 518-466-4972
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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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