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General NPI Number Information
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NPI Number | 1407098072
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Entity Type | Organization
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Legal Business Name | RENEW COUNSELING AND CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 03/29/2009
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Last Update Date | 03/29/2009
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Provider Practice Location Address
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Address Line | 100 N EDWARD GARY ST SUITE 110
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City | SAN MARCOS
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State | TX
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Zip | 78666-5726
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Country | US
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Telephone | 512-618-9415
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N EDWARD GARY ST SUITE 110
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City | SAN MARCOS
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State | TX
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Zip | 78666-5726
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Country | US
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Telephone | 512-618-9415
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT SHANNON HART
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Credential | MA, LPC-S, LSOTP-S
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Telephone | 512-618-9415
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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 | 15790
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License Number State | TX
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