MEDICARE: RESTORATION HOPE COUNSELING AND NEUROFEEDBACK, PLLC

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	:	1629610605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION HOPE COUNSELING AND NEUROFEEDBACK, PLLC

Provider Business Mailing Address
First Line	:	6901 S PIERCE ST STE 370
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-7202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 S PIERCE ST STE 370
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-7202
Country	:	US
Telephone Number	:	303-775-3684
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETHANY WILSN
Credential	:	MA, LPC, BCN, NCC
Telephone Number	:	636-699-7864

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	02/19/2020

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