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NPI Code Detail

MEDICARE: DR. RENITA HOGAN LPC-MHSP

MEDICARE: DR. RENITA HOGAN LPC-MHSP
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
1101YP2500XProfessional Counselor2594MS

General Provider Information

NPI Number : 1730639907
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENITA HOGAN LPC-MHSP
Provider Business Mailing Address
First Line : 429 E COMMERCE ST # 318
Second Line :
City : HERNANDO
State : MS
Zip : 38632-2348
Country : US
Telephone Number : 901-212-0014
Fax Number :
Provider Business Practice Location Address
First Line : 6000 POPLAR AVE STE 250
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3974
Country : US
Telephone Number : 901-212-0014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2016
Last Update Date : 02/23/2022

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