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General NPI Number Information
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NPI Number | 1285388140
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Entity Type | Organization
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Legal Business Name | RENEWED MIND ENRICHMENT THERAPY & COMMUNITY SERVICES NETWORK
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 5506 W CHESTNUT AVE, APT 222 5506 W CHESTNUT AVE, APT 222
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City | ENID
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State | OK
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Zip | 73703
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Country | US
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Telephone | 580-231-1659
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Fax | 855-629-7098
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Provider Business Mailing Address
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Address Line | 5506 W CHESTNUT AVE, APT 222 5506 W CHESTNUT AVE, APT 222
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City | ENID
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State | OK
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Zip | 73703
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Country | US
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Telephone | 580-231-1659
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Fax | 855-629-7098
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Authorized Official
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Title or Position | OWNER & LICENSED PROFESSIONAL THERA
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Name | DR. ANGELA MICHELLE JACKSON
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Credential | PHD, LPC
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Telephone | 580-231-1659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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