Life Restoration Center

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2007035322 Issued in MO

Legal business name

LIFE RESTORATION CENTER

Practice address

124 Wild Turkey LN
Troy, MO 63379-4339

Phone

(636) 358-6021

Fax

(636) 338-4911

NPI assigned

Oct 8, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Samantha Lee Graham-Douglas, LPCNPI 1538337159

Title

President

Phone

(636) 358-6021

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha L Graham-Douglas, LPC

  • Counselor
  • Troy, MO
  • NPI 1538337159

  Professional

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1417209917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 WILD TURKEY LN",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633794339",
            "telephone_number": "636-358-6021",
            "fax_number": "636-338-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 WILD TURKEY LN",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633794339",
            "telephone_number": "636-358-6021",
            "fax_number": "636-338-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE RESTORATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "GRAHAM-DOUGLAS",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-358-6021",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2007035322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538337159",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lewis Meyerson, MD
• Lewis Meyerson, MD, PC
• Arielle Faith Lewis, MSN, APRN, FNP-BC
• Charles Edward Lieberman III, O.D.
• Justin Clarke Liedke, PHARM.D.
• Madysen Taylar Lilley, FNP-BC
• Lincare Inc.
• Adrienne Linck
• Lincoln County Amb Dist
• Lincoln County Chiropractic LLC

• Professional Counselor in Troy, MO
• Providers in Troy, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.