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General NPI Number Information
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NPI Number | 1962080069
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Entity Type | Organization
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Legal Business Name | RESTORE THERAPY COLLECTIVE
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 2151 TENWAY DR SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506-4525
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Country | US
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Telephone | 248-761-4673
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Fax | 616-327-6333
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Provider Business Mailing Address
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Address Line | 2151 TENWAY DR SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506-4525
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Country | US
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Telephone | 248-761-4673
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Fax | 616-327-6333
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Authorized Official
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Title or Position | OWNER, LMFT
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Name | DR. JEN CREDIT HUTCHINGS
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Credential | PH.D
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Telephone | 248-761-4673
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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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