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General NPI Number Information
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NPI Number | 1386902765
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RECOVERY CENTER LLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 459 N GILBERT RD SUITE B140
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City | GILBERT
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State | AZ
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Zip | 85234-4591
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Country | US
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Telephone | 480-632-1345
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Fax | 480-632-1354
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Provider Business Mailing Address
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Address Line | 459 N GILBERT RD SUITE B140
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City | GILBERT
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State | AZ
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Zip | 85234-4591
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Country | US
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Telephone | 480-632-1345
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Fax | 480-632-1354
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN RALLIS BROWN
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Credential | L.C.S.W.
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Telephone | 480-632-1345
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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