Provider Demographics
NPI:1689473365
Name:RESTORED MIND
Entity type:Organization
Organization Name:RESTORED MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:ZANDSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LCSW
Authorized Official - Phone:616-710-1955
Mailing Address - Street 1:5242 PLAINFIELD AVE NE STE F
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1084
Mailing Address - Country:US
Mailing Address - Phone:616-710-1955
Mailing Address - Fax:
Practice Address - Street 1:5242 PLAINFIELD AVE NE STE F
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1084
Practice Address - Country:US
Practice Address - Phone:616-710-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health