Healthcare Provider Details

I. General information

NPI: 1881851707
Provider Name (Legal Business Name): RENEWAL MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 S 130TH CIR
OMAHA NE
68144-2528
US

IV. Provider business mailing address

2405 S 130TH CIR
OMAHA NE
68144-2528
US

V. Phone/Fax

Practice location:
  • Phone: 402-891-8882
  • Fax: 402-891-8883
Mailing address:
  • Phone: 402-891-8882
  • Fax: 402-891-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number52
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1452
License Number StateNE

VIII. Authorized Official

Name: JUDY DEVRIES
Title or Position: PARTNER
Credential:
Phone: 402-891-8882