Restoration Psychiatry PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

RESTORATION PSYCHIATRY PLLC

Practice address

2042 Wooddale Dr
Woodbury, MN 55125-2981

Phone

(651) 758-1899

NPI assigned

Jun 22, 2024

Organization subpart

No

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

Authorized official

Name

Akinbowale Ayeni, NPNPI 1639782626

Title

Ceo

Phone

(651) 734-5884

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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

• Akinbowale Ayeni

  • Psychiatric/Mental Health Nurse Practitioner
  • Eagan, MN
  • NPI 1639782626
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1719014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719014400000",
    "number": "1760226930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4548 BAILEY LAKE DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551295508",
            "telephone_number": "651-734-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2042 WOODDALE DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252981",
            "telephone_number": "651-758-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-22",
        "last_updated": "2024-06-22",
        "certification_date": "2024-06-22",
        "status": "A",
        "authorized_official_last_name": "AYENI",
        "authorized_official_first_name": "AKINBOWALE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-734-5884",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2024; 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.