| Restore Counseling & Recovery, Inc. | |
|
7399 Forest Hills Rd Loves Park IL 61111-3974 | |
| (815) 708-7392 | |
| (815) 708-8248 |
| Full Name | Restore Counseling & Recovery, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 7399 Forest Hills Rd, Loves Park, Illinois |
| Authorized Official Name and Position | Thomas G Mlodzik (CEO) |
| Authorized Official Contact | 4143249332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore Counseling & Recovery, Inc. 7399 Forest Hills Rd Loves Park IL 61111-3974 Ph: (815) 708-7392 | Restore Counseling & Recovery, Inc. 7399 Forest Hills Rd Loves Park IL 61111-3974 Ph: (815) 708-7392 |
| NPI Number | 1588909923 |
|---|---|
| Provider Enumeration Date | 12/11/2012 |
| Last Update Date | 08/18/2023 |
| Certification Date | 08/18/2023 |
| Medicare PECOS PAC ID | 0446497598 |
|---|---|
| Medicare Enrollment ID | O20130508000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588909923 | NPI | - | NPPES |
| Provider Name | Thomas G Mlodzik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013017169 PECOS PAC ID: 9739257882 Enrollment ID: I20081002000665 |
| Provider Name | Genevieve Maltby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649813452 PECOS PAC ID: 0244651677 Enrollment ID: I20200610002206 |
| Provider Name | Jennifer D Mitchell |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669093001 PECOS PAC ID: 4183074313 Enrollment ID: I20231229000721 |
| Provider Name | William Tiva Bounthong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144091505 PECOS PAC ID: 5799124459 Enrollment ID: I20240415003239 |
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