Organization
LIFE RESTORATION CENTER
Active
Organization
LIFE RESTORATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAMANTHA LEE GRAHAM-DOUGLAS LPC (PRESIDENT)
(636) 358-6021
Entity
Organization
Contact information
Practice address
124 WILD TURKEY LN, TROY, MO 63379-4339
(636) 358-6021
(636) 338-4911
Mailing address
124 WILD TURKEY LN, TROY, MO 63379-4339
(636) 358-6021
(636) 338-4911
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2007035322
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538337159
—
MO
Enumeration date
10/08/2012
Last updated
10/08/2012
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