Basic Information
| Provider Information | |||||||||
| NPI: | 1245603331 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RENEWED MINDS BEHAVIORAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 STUBBS AVE | ||||||||
| Address2: | SUITE E AND SUITE F | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185124997 | ||||||||
| FaxNumber: | 3186006095 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 STUBBS AVE | ||||||||
| Address2: | SUITE E AND SUITE F | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185124997 | ||||||||
| FaxNumber: | 3186006095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2015 | ||||||||
| LastUpdateDate: | 11/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | KARLIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3185479892 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.