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General NPI Number Information
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NPI Number | 1467301572
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Entity Type | Organization
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Legal Business Name | HEAL AND RENEW FAMILY COUNSELING CENTER, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 27789 KILDARE PL
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City | MORENO VALLEY
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State | CA
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Zip | 92555-5638
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Country | US
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Telephone | 951-268-4483
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6215
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City | MORENO VALLEY
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State | CA
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Zip | 92554-6215
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Country | US
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Telephone | 951-268-4483
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ELYSE DIANA DEJOHNETTE
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Credential | LMFT
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Telephone | 951-268-4483
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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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