=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760340822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORATIVE MINDSET & BEHAVIOR INSTITUTE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2026
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 W MILLBROOK RD STE 137
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-4398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-324-3143
-----------------------------------------------------
Fax | 984-220-9432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2920 FORESTVILLE RD STE 100-1082
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-8774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-324-3143
-----------------------------------------------------
Fax | 984-220-9432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER/PMHNP-BC
-----------------------------------------------------
Name | CRYSTAL PARKER
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 984-325-6143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------