Healthcare Provider Details

I. General information

NPI: 1033886908
Provider Name (Legal Business Name): RENEWED JOURNEY PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5442 E 5TH ST STE A
TUCSON AZ
85711-2334
US

IV. Provider business mailing address

PO BOX 19066
TUCSON AZ
85731-9066
US

V. Phone/Fax

Practice location:
  • Phone: 520-904-5277
  • Fax: 520-904-5277
Mailing address:
  • Phone: 520-904-5277
  • Fax: 855-718-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE Y FORD
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 520-904-5277