| Restore Behavioral Health Llc | |
|
2212 Westpark Dr Ste 105 Norman OK 73069-4098 | |
| (405) 919-1817 | |
| Not Available |
| Full Name | Restore Behavioral Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 2212 Westpark Dr Ste 105, Norman, Oklahoma |
| Authorized Official Name and Position | Gina Lynn Dixon (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4059191817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore Behavioral Health Llc 1008 24th Ave Nw Norman OK 73069-6369 Ph: (405) 919-1817 | Restore Behavioral Health Llc 2212 Westpark Dr Ste 105 Norman OK 73069-4098 Ph: (405) 919-1817 |
| NPI Number | 1083163083 |
|---|---|
| Provider Enumeration Date | 10/02/2016 |
| Last Update Date | 05/20/2024 |
| Certification Date | 05/20/2024 |
| Medicare PECOS PAC ID | 8628512647 |
|---|---|
| Medicare Enrollment ID | O20240702000951 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083163083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 5274 (Oklahoma) | Primary |
| Provider Name | Gina Lynn Dixon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356677934 PECOS PAC ID: 2264976281 Enrollment ID: I20240702001087 |
| Provider Name | Debra Conley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437192416 PECOS PAC ID: 0345786844 Enrollment ID: I20240719003596 |
| Provider Name | Lou Rae Woody |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1932132990 PECOS PAC ID: 3779020094 Enrollment ID: I20240805002619 |
| Provider Name | Molly Ross Ross Fuhrman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841505740 PECOS PAC ID: 1254878341 Enrollment ID: I20240807001917 |
| Provider Name | Rachel Cox |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285201285 PECOS PAC ID: 7618326869 Enrollment ID: I20240903001481 |
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