| Life Restoration Center | |
|
124 Wild Turkey Ln Troy MO 63379-4339 | |
| (636) 358-6021 | |
| (636) 338-4911 |
| Full Name | Life Restoration Center |
|---|---|
| Speciality | Counselor - Professional |
| Location | 124 Wild Turkey Ln, Troy, Missouri |
| Authorized Official Name and Position | Samantha Lee Graham-douglas (PRESIDENT) |
| Authorized Official Contact | 6363586021 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Restoration Center 124 Wild Turkey Ln Troy MO 63379-4339 Ph: (636) 358-6021 | Life Restoration Center 124 Wild Turkey Ln Troy MO 63379-4339 Ph: (636) 358-6021 |
| NPI Number | 1417209917 |
|---|---|
| Provider Enumeration Date | 10/08/2012 |
| Last Update Date | 10/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417209917 | NPI | - | NPPES |
| 1538337159 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2007035322 (Missouri) | Primary |
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