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General NPI Number Information
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NPI Number | 1174137517
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Entity Type | Organization
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Legal Business Name | RENEWED MIND COUNSELING SERVICE
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 2910 49TH ST
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City | VERO BEACH
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State | FL
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Zip | 32967-1275
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Country | US
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Telephone | 772-205-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 US HIGHWAY 1 STE 104-323
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City | VERO BEACH
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State | FL
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Zip | 32967-7600
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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 | OWNER
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Name | TRACY B. TAYLOR
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Credential |
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Telephone | 772-205-5065
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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