| Restoration | |
|
2421 W 7th St Ste 400 Fort Worth TX 76107-2388 | |
| (817) 291-9872 | |
| Not Available |
| Full Name | Restoration |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2421 W 7th St Ste 400, Fort Worth, Texas |
| Authorized Official Name and Position | Lee Long (CEO) |
| Authorized Official Contact | 4698789967 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoration 2421 W 7th St Ste 400 Fort Worth TX 76107-2388 Ph: (817) 291-9872 | Restoration 2421 W 7th St Ste 400 Fort Worth TX 76107-2388 Ph: (817) 291-9872 |
| NPI Number | 1649709601 |
|---|---|
| Provider Enumeration Date | 06/05/2017 |
| Last Update Date | 07/21/2022 |
| Certification Date | 06/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649709601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 19393 (* (Not Available)) | Primary |
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