1467618314 NPI number — KAYE RENSHAW, P.C., COUNSELING AND CONSULTATION

Table of content: (NPI 1467618314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467618314 NPI number — KAYE RENSHAW, P.C., COUNSELING AND CONSULTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAYE RENSHAW, P.C., COUNSELING AND CONSULTATION
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:
1467618314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50660
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79159-0660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-354-9997
Provider Business Mailing Address Fax Number:
806-354-9991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7480 GOLDEN POND PL
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79121-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-9997
Provider Business Practice Location Address Fax Number:
806-354-9991
Provider Enumeration Date:
07/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RENSHAW
Authorized Official First Name:
KAYE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
806-354-9997

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  12378 , 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: 0264285-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82624L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0264285-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122353100 . This is a "FIRST CARE SOUTHWEST LIFE AND HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 216750000 . This is a "MAGELLAN BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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