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General NPI Number Information
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NPI Number | 1043462757
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Entity Type | Organization
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Legal Business Name | MIND RENEWAL COUNSELING & COACHING, LLC
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 224 DATURA ST SUITE 407
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5624
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Country | US
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Telephone | 561-366-9111
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Fax | 561-366-9119
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Provider Business Mailing Address
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Address Line | 224 DATURA ST SUITE 407
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5624
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Country | US
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Telephone | 561-366-9111
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Fax | 561-366-9119
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHELLE A FORAKER
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Credential | ABD, LMHC, NCC
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Telephone | 561-366-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7843
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License Number State | FL
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