NPIMap

Organization Active NPI

Restoring Wellness Clinical Services, PLLC

  • Psychologist
  • Burr Ridge, IL
National Provider Identifier
1457990343
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
RESTORING WELLNESS CLINICAL SERVICES, PLLC
Practice address
200 S Frontage Rd Ste 320
Burr Ridge, IL 60527-6953
Phone
(630) 337-8006
Fax
(630) 581-5984
NPI assigned
Dec 25, 2019
Last updated
May 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Authorized official

Name
Dr. Andrea Michelle Graves, PSY.D.NPI 1609150960
Title
Licensed Clinical Psychologist
Phone
(630) 337-8006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU Primary
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

200 S Frontage Rd Ste 320
Burr Ridge, IL 60527-6953

Mailing address

200 S Frontage Rd Ste 320
Burr Ridge, IL 60527-6953
Phone (630) 337-8006

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.restoringwellness-clinical.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200609001228 IL Part B Supplier - Clinic/Group Practice 3274954722 Receives reassigned benefits from 8 practitioners
Practice locations: Burr Ridge, IL

National Provider Directory

National Provider Directory

Locations

200 S Frontage Rd
Ste 320
Burr Ridge, IL 60527
Phone (630) 337-8006

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1577232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589760000000",
    "number": "1457990343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S FRONTAGE RD STE 320",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276953",
            "telephone_number": "630-337-8006",
            "fax_number": "630-581-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S FRONTAGE RD STE 320",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276953",
            "telephone_number": "630-337-8006",
            "fax_number": "630-581-5984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORING WELLNESS CLINICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-25",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "630-337-8006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.restoringwellness-clinical.com",
            "affiliation": "N",
            "address_1": "1333 Burr Ridge Pkwy Ste 200",
            "city": "Burr Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605270833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.