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General NPI Number Information
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NPI Number | 1083066013
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Entity Type | Organization
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Legal Business Name | MIND RENWAL
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 1636 N HAMPTON RD SUITE 101
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City | DESOTO
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State | TX
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Zip | 75115-8621
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Country | US
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Telephone | 817-658-3812
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Fax |
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Provider Business Mailing Address
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Address Line | 1636 N HAMPTON RD SUITE 101
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City | DESOTO
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State | TX
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Zip | 75115-8621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. CHRISTINE JEFFRIES
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Credential | LPC
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Telephone | 817-239-8297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 70275
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 66609
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License Number State | TX
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