Provider Demographics
NPI:1992429740
Name:RESTORATIVE MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:RESTORATIVE MENTAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC/LPC
Authorized Official - Phone:737-251-5707
Mailing Address - Street 1:1604 INDUSTRY DR STE 108C
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4603
Mailing Address - Country:US
Mailing Address - Phone:737-222-4463
Mailing Address - Fax:737-238-3240
Practice Address - Street 1:1604 INDUSTRY DR STE 108C
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4603
Practice Address - Country:US
Practice Address - Phone:737-251-5707
Practice Address - Fax:737-222-4463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORATIVE MENTAL HEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty