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General NPI Number Information
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NPI Number | 1730639907
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Entity Type | Individual
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Provider Name | RENITA HOGAN LPC-MHSP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 6000 POPLAR AVE STE 250
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City | MEMPHIS
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State | TN
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Zip | 38119-3974
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Country | US
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Telephone | 901-212-0014
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Fax |
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Provider Business Mailing Address
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Address Line | 429 E COMMERCE ST # 318
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City | HERNANDO
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State | MS
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Zip | 38632-2348
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Country | US
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Telephone | 901-212-0014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2594
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License Number State | MS
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