MEDICARE: RESTORE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467289165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE COUNSELING LLC

Provider Business Mailing Address
First Line	:	7401 S BITTERROOT PL STE 301
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1610
Country	:	US
Telephone Number	:	605-405-8532
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 S BITTERROOT PL STE 301
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1610
Country	:	US
Telephone Number	:	605-405-8532
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	HELENA MARIE DUFAULT
Credential	:	MSW, CSW-PIP
Telephone Number	:	605-376-2691

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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