Healthcare Provider Details

I. General information

NPI: 1194297903
Provider Name (Legal Business Name): RENOVARE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W INDIANTOWN RD STE 200-56
JUPITER FL
33458-4628
US

IV. Provider business mailing address

18439 LAKE BEND DR
JUPITER FL
33458-3812
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-1707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN RAPP
Title or Position: PSYCHOLOGIST
Credential: PH.D
Phone: 561-223-1707