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General NPI Number Information
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NPI Number | 1538524582
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Entity Type | Organization
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Legal Business Name | RENEWED MINDS PLLC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 190 W SOUTH ST
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City | HERNANDO
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State | MS
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Zip | 38632-2245
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Country | US
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Telephone | 662-420-8208
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Fax |
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Provider Business Mailing Address
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Address Line | 190 W SOUTH ST
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City | HERNANDO
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State | MS
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Zip | 38632-2245
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Country | US
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Telephone | 662-420-8208
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Fax |
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Authorized Official
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Title or Position | SOLE PROPREITOR/ OWNER
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Name | MARQUITA DR THURMAN
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Credential | LCSW
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Telephone | 662-420-8208
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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 | 1079661
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License Number State | MS
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