Healthcare Provider Details

I. General information

NPI: 1427979095
Provider Name (Legal Business Name): RENEWED MIND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 NORTHWIND DR
MARION AR
72364-3010
US

IV. Provider business mailing address

214 NORTHWIND DR
MARION AR
72364-3010
US

V. Phone/Fax

Practice location:
  • Phone: 901-410-3446
  • Fax:
Mailing address:
  • Phone: 870-295-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COREY FOREMAN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 870-295-0299