Healthcare Provider Details

I. General information

NPI: 1588531370
Provider Name (Legal Business Name): RUACH RENEWAL THERAPY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 NW 91ST AVE
CORAL SPRINGS FL
33065-5066
US

IV. Provider business mailing address

2833 NW 91ST AVE
CORAL SPRINGS FL
33065-5066
US

V. Phone/Fax

Practice location:
  • Phone: 954-856-0054
  • Fax:
Mailing address:
  • Phone: 954-856-0054
  • 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: JACQUELINE M MCINTOSH
Title or Position: OWNER
Credential: LMHC
Phone: 954-856-0054