Healthcare Provider Details

I. General information

NPI: 1023615846
Provider Name (Legal Business Name): RENEWING MINDS COUNSELING AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 AILANTHUS CT
TALLAHASSEE FL
32305-5003
US

IV. Provider business mailing address

4047 AILANTHUS CT
TALLAHASSEE FL
32305-5003
US

V. Phone/Fax

Practice location:
  • Phone: 850-692-9268
  • Fax:
Mailing address:
  • Phone: 850-692-9268
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO LAMAR WYCHE
Title or Position: CO-OWNER
Credential: LCSW
Phone: 850-692-9268