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General NPI Number Information
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NPI Number | 1760950927
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Entity Type | Organization
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Legal Business Name | RENAISSANCE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4760 S PECOS RD STE 203-6
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City | LAS VEGAS
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State | NV
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Zip | 89121-6038
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Country | US
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Telephone | 702-930-5958
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 620251
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City | LAS VEGAS
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State | NV
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Zip | 89162-0251
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Country | US
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Telephone | 702-241-8202
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. GWENDOLYN TERESE GREENE
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Credential | DBH, MS, LMFTI
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Telephone | 702-241-8202
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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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