Provider Demographics
NPI:1568235935
Name:RESTORATION MENTAL HEALTH
Entity type:Organization
Organization Name:RESTORATION MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-725-3555
Mailing Address - Street 1:1820 E 17TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6400
Mailing Address - Country:US
Mailing Address - Phone:208-725-3555
Mailing Address - Fax:
Practice Address - Street 1:1820 E 17TH ST STE 330
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6400
Practice Address - Country:US
Practice Address - Phone:208-725-3555
Practice Address - Fax:659-223-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty