Healthcare Provider Details

I. General information

NPI: 1467183137
Provider Name (Legal Business Name): RENEWING OF THE MIND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12097 OLD HAMMOND HWY STE G1
BATON ROUGE LA
70816-8679
US

IV. Provider business mailing address

12097 OLD HAMMOND HWY STE G1
BATON ROUGE LA
70816-8679
US

V. Phone/Fax

Practice location:
  • Phone: 225-401-2255
  • Fax: 225-351-8925
Mailing address:
  • Phone: 225-401-2255
  • Fax: 225-351-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY N GASTON
Title or Position: OWNER
Credential: LPC
Phone: 225-401-2255