MEDICARE: RESTORATION PSYCHOLOGY, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487271326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION PSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	5000 BIG ISLAND DR UNIT 506
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-5340
Country	:	US
Telephone Number	:	318-820-6795
Fax Number	:

Provider Business Practice Location Address
First Line	:	7545 CENTURION PKWY STE 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4118
Country	:	US
Telephone Number	:	318-820-6795
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. SARAH COREY PATTON
Credential	:	PSYD
Telephone Number	:	318-820-6795

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	08/22/2022

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