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NPI Code Detail

MEDICARE: RENEWED MENTAL HEALTH LLC

MEDICARE: RENEWED MENTAL HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1235797077
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENEWED MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : PO BOX 15442
Second Line :
City : CLEARWATER
State : FL
Zip : 33766-5442
Country : US
Telephone Number : 727-275-2684
Fax Number :
Provider Business Practice Location Address
First Line : 2430 ESTANCIA BLVD STE 106
Second Line :
City : CLEARWATER
State : FL
Zip : 33761-2607
Country : US
Telephone Number : 727-275-2684
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : WILIAM MCCORMACK
Credential : LMHC
Telephone Number : 727-275-2684
Provider Enumeration Date : 06/05/2019
Last Update Date : 06/05/2019

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Directions to “RENEWED MENTAL HEALTH LLC ” Practice Location

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