=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033483920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEWED STRENGTH COUNSELING , LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2012
-----------------------------------------------------
Last Update Date | 09/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 S INTERSTATE DR
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-8641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-576-1896
-----------------------------------------------------
Fax | 888-340-7785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 S INTERSTATE DR
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-8641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-576-1896
-----------------------------------------------------
Fax | 888-340-7785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OUTPATIENT THERAPIST, OWNER
-----------------------------------------------------
Name | MRS. JENNIFER L OWENS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 573-576-1896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 2012002898
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------