MEDICARE: RESTORING LIVES COUNSELING & WELLNESS CENTER 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	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1700274172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORING LIVES COUNSELING & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	6151 MIRAMAR PKWY STE 200
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-3972
Country	:	US
Telephone Number	:	305-814-3437
Fax Number	:	954-256-7386

Provider Business Practice Location Address
First Line	:	6151 MIRAMAR PKWY STE 200
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-3972
Country	:	US
Telephone Number	:	305-814-3437
Fax Number	:	954-256-7386

Authorized Official
Title or Position	:	CLINICAL DIRECTOR/THERAPIST
Name	:	MS. EDLYNE THELUSMA
Credential	:	LMHC
Telephone Number	:	305-814-3437

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	04/24/2024

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