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Organization

RESTORATION COUNSELING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KELLY L SHORES MA (OWNER/THERAPIST)
(317) 710-7772
Entity
Organization

Contact information

Practice address
415 W BROADWAY ST STE E, FORTVILLE, IN 46040-1462
(317) 710-7772
Mailing address
415 W BROADWAY ST STE E, FORTVILLE, IN 46040-1462
(317) 710-7772

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
86000251A
IN
106H00000X
Marriage & Family Therapist
Primary
35001781A
IN

Other

Enumeration date
06/17/2015
Last updated
06/17/2015
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