Healthcare Provider Details

I. General information

NPI: 1114844024
Provider Name (Legal Business Name): RENEWED VISION COUNSELING AND IDD SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MCDANIEL ST
TYRONZA AR
72386-2007
US

IV. Provider business mailing address

121 MCDANIEL ST
TYRONZA AR
72386-2007
US

V. Phone/Fax

Practice location:
  • Phone: 402-889-8395
  • Fax:
Mailing address:
  • Phone: 402-889-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LYNN MARSHALL
Title or Position: BOARD CHAIRMAN
Credential:
Phone: 402-889-8395