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General NPI Number Information
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NPI Number | 1598089088
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Entity Type | Organization
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Legal Business Name | RENAISSANCE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 1101 N LITTLE SCHOOL RD SUITE B
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City | ARLINGTON
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State | TX
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Zip | 76017-1900
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Country | US
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Telephone | 817-939-2376
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Fax | 817-478-4656
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Provider Business Mailing Address
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Address Line | 1101 N LITTLE SCHOOL RD SUITE B
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City | ARLINGTON
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State | TX
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Zip | 76017-1900
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Country | US
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Telephone | 817-939-2376
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Fax | 817-478-4656
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/OWNER
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Name | DR. ANGELA D. MITCHELL
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Credential | PHD
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Telephone | 817-939-2376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32135
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License Number State | TX
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