Organization
RESTORE FX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYKEISHA P. SIMS (ADMINISTRATOR)
(512) 334-2149
Entity
Organization
Contact information
Practice address
4534 W GATE BLVD, SUITE 112, AUSTIN, TX 78745-1485
(512) 439-7360
Mailing address
4534 W GATE BLVD, SUITE 112, AUSTIN, TX 78745-1485
(512) 439-7360
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
F5318
TX
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
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