# RESTORE FX

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467630608
- **Authorized official:** TYKEISHA P. SIMS (ADMINISTRATOR)
- **Authorized official phone:** (512) 334-2149

## Contact information

- **Practice address:** 4534 W GATE BLVD, SUITE 112, AUSTIN, TX 78745-1485
- **Practice address phone:** (512) 439-7360
- **Mailing address:** 4534 W GATE BLVD, SUITE 112, AUSTIN, TX 78745-1485
- **Mailing address phone:** (512) 439-7360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | F5318 | TX | Yes |
| 103T00000X | Psychologist | 26883 | TX | — |
| 1041C0700X | Clinical Social Worker | 34223 | TX | — |
| 225100000X | Physical Therapist | 1132165 | TX | — |

## Other

- **Enumeration date:** 02/08/2008
- **Last updated:** 10/22/2012