1407343759 NPI number — REVENIR COUNSELING AND WELLNESS, PLLC

Table of content: CINDY BROSIG RN (NPI 1205465408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407343759 NPI number — REVENIR COUNSELING AND WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REVENIR COUNSELING AND WELLNESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407343759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4131 SPICEWOOD SPRINGS RD STE H2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-8659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-262-4577
Provider Business Mailing Address Fax Number:
855-765-7552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4131 SPICEWOOD SPRINGS RD STE H2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-262-4577
Provider Business Practice Location Address Fax Number:
855-765-7552
Provider Enumeration Date:
04/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PARNELL
Authorized Official First Name:
DIXON
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER/SOLE PRACTITIONER
Authorized Official Telephone Number:
901-262-4577

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  71606 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 71606 . This is a "TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com