NPIMap

Organization Active NPI

Restore Life Behavioral Health

  • Professional Counselor
  • Hendersonville, TN
National Provider Identifier
1881174787
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3685 Issued in TN
Legal business name
RESTORE LIFE BEHAVIORAL HEALTH
Practice address
100 Country Club Dr Ste 200
Hendersonville, TN 37075
Phone
(615) 348-5806
Fax
(615) 285-8130
NPI assigned
Aug 20, 2018
Last updated
Sep 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Authorized official

Name
Mrs. Shervetta Porter, MA, LPCNPI 1922180983
Title
Owner
Phone
(615) 348-5806

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
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 3685 TN Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 6289 TN
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 3685 TN

Addresses

Primary practice location

100 Country Club Dr Ste 200
Hendersonville, TN 37075

Mailing address

100 Country Club Dr Ste 200
Hendersonville, TN 37075-4376
Phone (615) 348-5806

Other practice location 1

635 E Main St Ste 3
Hendersonville, TN 37075
Phone (615) 348-5806 ext. 1

Other practice location 2

128 N 2nd St Ste 202
Clarksville, TN 37040-6460
Phone (615) 348-5806

Other identifiers 1

IdentifierTypeStateIssuer
Q027516MedicaidTN

National Provider Directory

National Provider Directory

Locations

128 N 2nd St
Ste 202
Clarksville, TN 37040
Phone (615) 802-8837

100 Country Club Dr
Ste 200
Hendersonville, TN 37075
Phone (615) 423-1140

635 E Main St
Ste 3
Hendersonville, TN 37075
Phone 6153485806 ext. 1

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567468800000",
    "number": "1881174787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COUNTRY CLUB DR STE 200",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370754376",
            "telephone_number": "615-348-5806",
            "fax_number": "615-285-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTRY CLUB DR STE 200",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "37075",
            "telephone_number": "615-348-5806",
            "fax_number": "615-285-8130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "635 E Main St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Hendersonville",
            "state": "TN",
            "postal_code": "37075",
            "country_code": "US",
            "telephone_number": "615-348-5806 x1",
            "fax_number": "615-285-8130",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 N 2nd St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370406460",
            "country_code": "US",
            "telephone_number": "615-348-5806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RESTORE LIFE BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-20",
        "last_updated": "2019-09-03",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "SHERVETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-348-5806",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "3685",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "6289",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "TN",
            "license": "3685",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q027516",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.