1518234194 NPI number — RENEWED COUNSELING SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518234194 NPI number — RENEWED COUNSELING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENEWED COUNSELING SERVICE
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:
1518234194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13051 GROVE PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78253-5755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-289-8405
Provider Business Mailing Address Fax Number:
210-679-6705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 NE LOOP 410
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-5213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-289-8405
Provider Business Practice Location Address Fax Number:
210-679-6705
Provider Enumeration Date:
11/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DEMPSEY
Authorized Official First Name:
TARI
Authorized Official Middle Name:
SUZETTE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-289-8405

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  63113 , 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: 202676701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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