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General NPI Number Information
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NPI Number | 1437042298
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Entity Type | Organization
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Legal Business Name | RENEWANCE BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1014 E 18TH ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-4307
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Country | US
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Telephone | 931-980-9063
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 E 18TH ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-4307
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Country | US
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Telephone | 931-980-9063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY BURSE
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Credential | NURSE PRACTITIONER
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Telephone | 931-980-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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