Healthcare Provider Details

I. General information

NPI: 1184496523
Provider Name (Legal Business Name): RENEWED MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11915 P ST STE 103
OMAHA NE
68137-2236
US

IV. Provider business mailing address

6201 KENTUCKY RD
PAPILLION NE
68133-2372
US

V. Phone/Fax

Practice location:
  • Phone: 402-862-6762
  • Fax:
Mailing address:
  • Phone: 402-862-6762
  • Fax: 402-718-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURIE JOHNSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 402-862-6762