Healthcare Provider Details

I. General information

NPI: 1366945313
Provider Name (Legal Business Name): RENEWED VISION COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N MAIN ST
SEARCY AR
72143-5421
US

IV. Provider business mailing address

100 DOUGLAS PL
SEARCY AR
72143-8655
US

V. Phone/Fax

Practice location:
  • Phone: 501-305-0555
  • Fax: 866-350-3336
Mailing address:
  • Phone: 866-507-9994
  • Fax: 866-350-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP0907041
License Number StateAR

VIII. Authorized Official

Name: MICHAEL S JONES
Title or Position: OWNER
Credential:
Phone: 866-507-9994