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General NPI Number Information
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NPI Number | 1932084969
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Entity Type | Organization
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Legal Business Name | MINDFUL RESTORATION, LLC
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 330 E MADISON AVE
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City | DERBY
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State | KS
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Zip | 67037-1739
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Country | US
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Telephone | 316-847-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 2243 N HORSESHOE CIR
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City | DERBY
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State | KS
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Zip | 67037-8657
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Country | US
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Telephone | 816-225-5387
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DEBRA J MORGAN
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Credential |
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Telephone | 816-225-5387
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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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