MEDICARE: RENEWED RELATIONSHIPS COUNSELING GROUP

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
1	101YM0800X	Mental Health Counselor	88613	CA

General Provider Information

NPI Number	:	1336626795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED RELATIONSHIPS COUNSELING GROUP

Provider Business Mailing Address
First Line	:	864 S ROBERTSON BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	864 S ROBERTSON BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1628
Country	:	US
Telephone Number	:	424-302-8227
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHANIE MACADAAN
Credential	:	LMFT
Telephone Number	:	424-302-8227

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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